
Class. 
Book 



COPYRICHT DEPOSIT 



A TEXT-BOOK 



OF 



PRACTICAL THERAPEUTICS, 



WITH ESPECIAL REFERENCE TO THE 



APPLICATION OF REMEDIAL MEASURES TO DISEASE 



AND THEIR 



EMPLOYMENT UPON A RATIONAL BASIS. 



BY 

HOBAKT AMORY HARE, M. D., B.Sc, 

PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF 
PHILADELPHIA; PHYSICIAN TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL; ONE-TIME 
CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE UNIVERSITY OF PENNSYL- 
VANIA ; LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BELGIUM, 
OF THE MEDICAL SOCIETY OF LONDON ; CORRESPONDING FELLOW OF 
THE SOCIEDAD ESPANOLA DE HIGIENE OF MADRID; AUTHOR 
OF "A TEXT-BOOK OF PRACTICAL DIAGNOSIS," ETC. 



NINTH EDITION, ENLARGED, THOROUGHLY REVISED AND LARGELY RE -WRITTEN. 
ILLUSTRATED WITH 105 ENGRAVINGS AND 4 COLORED PLATES. 




LEA BROTHERS & CO., 

PHILADELPHIA AND NEW YORK. 

1902 



THE LIBRARY OF 
CONGRESS, 

Two Copies Received 

IUN. 4 1902 

_ Copyright entry 

< class ^-xxc. no 

COPY B. 



*$ 



4V 



\ 



PS 



Entered according to Act of Congress, in the year 1902, "by 

LEA BEOTHEES & CO., 

in the Office of the Librarian of Congress. All rights reserved. 



WE5TCOTT & THOMSON. 
ELECTROTYPERS. PHILAOA. 



THIS VOLUME 



IS DEDICATED TO 



Dr. J. WILLIAM WHITE, 

PROFESSOR OP CLINICAL SURGERY IN THE UNI\ ERSITY OP PENNSYLVANIA. 



EVIDENCE OF FRIENDSHIP AND ESTEEM, 



THE AUTHOR 



PREFACE TO THE NINTH EDITION. 



In the preparation of the first edition of this book the Author 
endeavored to present scientific facts and practical therapeutic measures 
in such a manner as to render the former interesting and the latter 
rational. It seemed to him that the scientific investigator and the 
bedside clinician, instead of being married were being divorced, and 
that a book was needed which would provide the practising physician 
not only with facts from the laboratory, which he might take advan- 
tage of at the bedside, but also with one which would provide concise 
information concerning the best methods of treating disease. 

In this ninth edition the Author has endeavored to make such 
changes and additions as will render the work still more useful to 
the practitioner and student. Not only has he carefully revised all 
the text, but also included all new measures which seem useful, and in 
addition has added nearly one hundred illustrations, a large number 
of which show the actual application of the procedure described ; as, 
for example, the uses of cold water as a remedial agent, cupping, 
leeching, lavage, gavage, and the use of inhalations in the treatment 
of respiratory disorders. In many respects, therefore, the book can 
be considered almost a new one upon a subject which is interesting 
to all practitioners of medicine. 

Philadelphia, N. W. Cor. Spruce and Eighteenth Sts. 
May, 1902. 



PREFACE TO THE EIGHTH EDITION. 



The call for eight editions of this book, each of them larger 
than its predecessor, in less than ten years has afforded the author fre- 
quent opportunities for revision of the text ; and that these revisions 
have increased its popularity is shown by the fact that the first 2000 
copies of the seventh edition were exhausted within six weeks of 
the day of issue. In the present edition many therapeutic facts of 
value have been added, the general text carefully revised, and an 
effort made to render the book still more useful for quick reference on 
the part of the busy practitioner. In addition to this a large number 
of important new remedies which have stood the test of clinical expe- 
rience during the past two years have been added. In order that 
the physiological effects of drugs may be more readily understood, 
a number of illustrations showing those portions of the body upon 
which the drugs exercise their dominant influence have been intro- 
duced, and it is hoped that this feature will make the book still more 
valuable to students. 

Warm thanks are also due to the author's friends, Dr. George E. 
de Schweinitz, Professor of Ophthalmology in the Jefferson Medical 
College, for his careful revision and rewriting of the sections devoted 
to the treatment of the common diseases of the eye ; Dr. Edward Mar- 
tin, Clinical Professor of Genito-Urinary Diseases in the University 
of Pennsylvania, for similar service in connection with the articles on 
antiseptics, gonorrhoea, and syphilis ; and Dr. Barton Cooke Hirst, 
Professor of Obstetrics in the University of Pennsylvania, for the 
revision of the article on puerperal disorders. 

Philadelphia, 222 S. Fifteenth St. 
April, 1900. 



PREFACE TO THE FIRST EDITION. 



The object of this book is to provide the physician or under- 
graduate student of medicine with a reliable guide in the study of 
Therapeutics, or the application of remedial measures for the cure 
of disease. It has been written because, in the belief of the author, 
most of the text-books on this subject treat of it as if the student were 
already a skilled physician or experimental pharmacologist. As a 
consequence, two classes of undergraduate readers exist. One finds 
that the mixture of science and empiricism is too difficult for him to 
fathom, and is hopelessly confused; the other simply learns the reme- 
dies and doses by heart, and gives drugs with little idea as to what 
they are to do. Further than this, the physician is often at a loss to 
decide when a remedy is indicated, even though his theoretical know- 
ledge of the subject be very thorough. Thus, he is told that ammo- 
nium chloride is a remedy in bronchitis, but the exact stage at which 
it is to be employed is often not stated ; or he knows that digitalis 
does good in cases of cardiac disease, but fails to recognize the fact 
that it is only when compensation is lacking that the drug is needed. 
For this reason Part IV. has been written, not with the object of 
providing a rigid system for treating disease, but rather for the pur- 
pose of bringing together the best remedies, and of showing how and 
why they are given. 

Rational therapeutics at the present day does not consist in a 
knowledge of doses and the materia medica, but exists as a complex 
art in which knowledge and its proper application, based on common- 
sense principles, go hand in hand. The treatment of " symptoms as 
they arise " by the employment of remedies recommended by some 

eminent authority is a variety of empiricism whose existence has 

11 



12 PREFACE TO THE FIRST EDITION. 

depended largely on the fact that many physicians of the past have 
either been so ignorant as to be led where a writer willed, or so sloth- 
ful as to be willing to let others think for them. Scientific research 
has so largely opened up to every one the possibility of using drugs 
with a distinct idea of the reason for their employment that the 
writer has endeavored to bring together in a readable form the com- 
bined results of laboratory and bedside experience, thinking the time 
ripe for such a task. It is true that several other books give, in a 
more or less thorough manner, a resume of the physiological action 
of the drugs of which they treat, but in even the best of them only 
the most trained student of pharmacology can discover the close rela- 
tionships which exist between the results reached by the physiologist 
on the one hand and the clinician on the other. The two parts of the 
study are usually so divorced by the prolonged mental effort neces- 
sitated by the arrangement of the text that the student either ignores 
the physiological action for the sections on therapeutics, or crams the 
former to pass an examination required by the teacher whose course 
he must follow. As a consequence, too many physicians regard 
pharmacology simply as a species of mental training, or believe it to 
be a waste of time and energy. No one can think that the writer of 
this book will ever deny the value of original research or bedside 
experience, but he does desire to weave science and practice into so 
close a network that the foundations of experience may be cemented 
by the mortar of exact knowledge. In some instances, however, 
science and practice seem to be absolutely opposed, and only future 
research can explain the apparent contradiction. 

Throughout this book, in every part where drugs or diseases are 
considered, the writer has arranged the titles in alphabetical order, 
according to their English names. This has been done because it is 
desired to afford the reader a ready-reference book to which he may 
turn at short notice for desired information, for at present the state 
of pharmacology is so unsettled that a true classification is impossible. 
Thus, morphine may be classed by one writer as a nervous sedative, 
by another as ;i sleep-producer, by a third as a bitter substance, and 
by a fourth as a respiratory depressant. Bromide of potassium can 



PREFACE TO THE FIRST EDITION. 13 

with equal propriety be called a spinal sedative or a cerebral seda- 
tive, or caffeine be classed as a cerebral stimulant, a circulatory stim- 
ulant, or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopoeia have been introduced ; and with the same 
object in view, a dose-list of drugs, both official and unofficial, has 
been appended for ready reference. The subject of medical elec- 
tricity has heretofore commonly found a place in most text-books on 
therapeutics, but has been advisedly omitted in this instance, since 
electrical therapeutics has outgrown any work save one devoted to 
that subject alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their special- 
ties. Thus Dr. G. E. de Schweinitz has contributed the articles on 
the treatment of diseases of the eye ; Dr. Edward Martin, those on 
the treatment of venereal diseases and on antisepsis ; Dr. Barton C. 
Hirst, those on the treatment of diseases of the puerperal state. All 
of these articles enhance the value of the book to so great an extent 
that the author feels sure they will be sought out and read with 
interest. 

In addition to the general index, a copious and explanatory index 
of diseases and remedies has been appended, which will prove sug- 
gestive and valuable to practitioners, and for which the author is 
indebted to his friend and student, Mr. J. Gr. Clark. 

Philadelphia, 222 South Fifteenth Street. 
Sept., 1890. 



CONTENTS 



PART I. 

PAGE 

General Therapeutical Considerations 17 



PART II. 

Drugs 51 

PART III. 

Remedial Measures other than Drugs 433 

Feeding the Sick 509 

PART IY. 

Diseases 521 

Table of Doses of Medicines 777 

Index of Drugs and Remedial Measures 793 

Index of Diseases and Remedies ' 813 



15 



PART I. 
GENERAL THERAPEUTICAL CONSIDERATIONS. 



Before entering into a study of the action of drugs upon a living 
body, it is necessary that the student should possess a clear idea of 
what the word " therapeutics " means, the reason why we resort to 
drugs, and, more important than all, that he should grasp the limita- 
tions which govern the administration of remedies. 

Two very foolish and unfounded ideas have been put forward 
by certain persons — one being, that medical therapeutics is use- 
less ; and the other, that this branch of medical knowledge is not 
advancing with so great a stride as is pathology or surgery. The 
individuals who deride the use of drugs in disease belong to one of 
two classes : either they have never tried them or have used the 
drugs ignorantly or wrongly. 

The statement that therapeutics is to-day less advanced than are 
pathology and surgery is readily answered by a denial ; for the thera- 
peutist is able to treat successfully many diseases of which the pathol- 
ogist knows nothing, and is obliged to rest his treatment on empiri- 
cism simply because he cannot tell how his drugs act if the pathologist 
cannot tell him in what the disease consists. Rheumatism and syphilis 
are good examples of this very point. 

In regard to surgery, every one must recognize the extraordinary 
advances made in this branch of medical science, yet comparatively 
few realize that it is solely by the proper use of drugs that all its 
triumphs are possible. The definition of the word " therapeutics " in 
Billings's Dictionary is : u That branch of medical science which treats 
of the application of remedies to the cure or alleviation of disease " ; and 
practically the term is almost universally used to signify the employment 
of drugs for such purposes. The credit for the introduction of new 
instruments and operations may be accorded to surgery, but the dis- 
covery of new drugs must be accorded to therapeutics. We find, then, 
that ether and chloroform began to revolutionize surgery sixty years 
ago, and that corrosive sublimate and other drugs have revolutionized 
it once more within the lifetime of every one who reads this book. 
Cocaine has changed the entire aspect of eye surgery and other minor 
operations, and has immediately averted an enormous amount of pain 
and suffering which the surgeon could not mitigate, much less remove, 
in the absence of its influence. To the accusation of backwardness 

2 17 



18 GENERAL THERAPEUTICAL CONSIDERATIONS. 

the therapeutist can well reply by asking the champion of any other 
branch of medical science to put forward one discovery which equals 
antipyrine or acetanilid in power to relieve pain ; and last, but by no 
means least, he can point to those triumphs of modern therapeutics — 
the use of suprarenal gland as a vasoconstrictor, of thyroid gland for 
myxoedema, and of antitoxin for diphtheria. 

The man who does not believe in the proper use of remedies for 
the cure of disease lacks the very keystone of the arch upon which all 
medical investigation rests, for the ultimate aim and object of all 
medical thought and effort is the cure or alleviation of disease. Like 
every other thing requiring a thorough knowledge of its component 
parts, methods of treatment are often much abused by the careless and 
ignorant, but are a power for good in the trained hand of the properly 
educated physician. 

Further than this, therapeutics is the only universally used part 
of medicine, for each and every branch must resort to it, and the 
most skilful operator who fails to treat his cases medicinally with 
equal skill will have worse results than he who, though bungling in 
his surgery, yet uses drugs intelligently after his slashing is finished. 

Homoeopathy depends upon more than one reason for its exist- 
ence. If infinitesimal doses are given, the patient is satisfied that 
he is receiving medicine, and Nature often produces her most rapid 
cures when left alone. Again, the entire basis of homoeopathic thera- 
peutics rests not upon the stud} 7 of the causes of diseases, but upon 
the symptoms which constantly present themselves. As a result of 
this, many minor symptoms are relieved and the patient's confidence 
is won, but nothing is done to control the pathological process itself. 
No detail of diagnosis or treatment should be too small to attract the 
attention of the regular physician. 

The first duty of the physician when called to a case of illness is to 
reach a diagnosis as to the cause of the ailment, and not until he 
has formed a definite idea as to the condition which confronts him 
should he prescribe any medicinal agent. In certain cases where 
the symptoms are severe or indicative of immediate danger it may 
be necessary to give relief by the use of temporary remedies, not 
only to save life, but to remove symptoms which, because of their 
-(•verity, mask the case so that a diagnosis is impossible. Thus a 
patient may be found in collapse or in a state of syncope. The 
cause of this state may be obscure, but the pulse, heart-sounds, 
and respiratory action may indicate the need of immediate stimula- 
tion. In another instance agonizing pain, as that due to a crisis in 
locomotor ataxia, or renal or hepatic colic, may require a hypodermic 
injection of morphine as soon as the physician assures himself that 
the pain complained of is genuine. In other instances the case may 
be. so obscure that several days of careful study may be necessary to 
reach ;t correct diagnosis, and during this time palliative remedies may 
he required. 

Before ordering a drug or method of treatment the physician should 
have ;i clear conception of what he is trying to accomplish. No 
remedy should be given unless there is a distinct indication for its use. 



GENERAL THERAPEUTICAL CONSIDERATIONS, 19 

The old-fashioned "shotgun " prescription, containing many ingredi- 
ents, one or more of which might hit the mark, should be supplanted 
by the small-calibre rifle-ball sent with directness at the condition to 
be relieved. Having decided upon the remedy indicated, the physi- 
cian must next determine the dose required. This latter decision is 
almost as important as the first, for very often an error in dosage 
will cause failure of the remedy. A large part of the therapeutic 
skill of the physician consists in fitting the dose to the needs of his 
patient. 

In the treatment of all forms of disease the physician must never 
forget the following influential factors in the case, which are often of 
greater importance than the measures devoted to the treatment of the 
disease itself: 

1. The maintenance of vital resistance by proper feeding. 

2. The elimination of effete materials by the kidneys, bowels, 

and skin. 

3. The relief of annoying symptoms which sap the patient's 

vitality and often obscure the true state of the system. 

4. That sufficient physical and mental rest and sleep are obtained 

if possible. 

1. That the proper use of food in both acute and chronic illness is of 
great importance is not only manifest, but it has been proved by 
scientific investigation that lack of food often prevents the system 
from successfully combating the entrance and growth of infecting 
micro-organisms. The patient who has a greatly lowered vital resist- 
ance not only suffers from the effects of the particular disease by which 
he has been attacked, but not rarely dies from the growth of other 
micro-organisms which find him a fair mark for their attacks, thereby 
producing what Flexner has well called "terminal infections," and 
causing Osier to say that " a man rarely dies of the disease from which 
he is suffering," meaning by this that though he may be ill of a specific 
infection, other germs really produce the fatal issue. Care in feeding 
is therefore never to be ignored, and the various ways of feeding and 
preparing foods must be carefully studied. (See Part III.) 

2. It would seem hardly necessary to insist on the importance of 
maintaining the active elimination of impurities from the body were it 
not that so little attention is paid by some physicians to these functions. 
In all infectious diseases the kidneys are required not only to elimi- 
nate the ordinary waste products of the body, which usually escape in 
this way, but in addition the increased waste produced by the fever 
and the poisons produced directly and indirectly by the growth of the 
invading micro-organisms. It is essential therefore that the patient 
shall pass urine in sufficient amount to carry off these substances, and 
this result often may be attained by giving plenty of water to drink 
and increasing diuresis by the use of sweet spirit of nitre and citrate, or 
acetate, of potassium. Nor is it sufficient to see that the quantity of 
urine is normal. Estimations of the urea should be made in all serious 
cases, to determine whether the actual eliminating function of the kidney 
is active, for sometimes the flow of urine is sufficient, but the quantity 
of urinary solids is far below what it should be. Not rarely in disease, 



20 GENERAL THERAPEUTICAL CONSIDERATIONS. 

or even in apparent health, the patient states that he has had his bowels 
moved daily, and the physician is content with this report without 
making any inquiries as to the quantity of the feces or whether the 
quantity is adequate in regard to the amount of food ingested. Even 
when the bowels are moved daily we may find after some days that there 
has been a partial retention of faecal matter, so that the colon be- 
comes filled with faeces. Sometimes moderate diarrhoea is an effort of 
nature to eliminate poisons, and is to be regarded as an aid to the 
patient, and not arrested by constipating remedies. It is also to be 
recalled that one of the functions of the liver is the elimination and 
destruction of toxic materials, and therefore the use of a cholagogue 
not only unloads the bowel, but aids the liver in one of its most im- 
portant duties. As the skin is an important eliminating organ, it must 
be kept clean by frequent washing, and if inactive it must be stimu- 
lated to increased activity by rubbing, and in some cases by hot packs 
or Turkish baths. (See Heat.) 

3. It is of importance, as already stated, that symptoms which 
accompany the progress of various forms of diseases should be modified 
or removed if they become sufficiently active to produce much discom- 
fort or disturb the patient's rest. Headache, backache, itching, wind 
colic, etc., can often be entirely removed by simple means, and some- 
times without the internal use of drugs. It is, on the one hand, im- 
portant to avoid unnecessary discomfort ; and, on the other, care must 
be taken that in the use of remedies to relieve annoying symptoms 
Ave do not mask important diagnostic factors in the case or influence 
unfavorably the course of the malady. Thus in appendicitis it is wise, 
as a rule, not to give morphine to relieve the pain, as it will quiet the 
patient so as to lead him and his attendants to regard the condition as 
actually healed, when in reality the pathological process is rapidly 
progressing. Only when the pain is agonizing ought w r e to give suffi- 
cient of the drug to allay the excess of pain, and never enough to mask 
the real condition. It is of vital importance that the physician be not 
content with the relief of symptoms alone, but that he shall regard 
them as of little importance, while he searches for and, having 
found, tries to remedy the diseased state itself. Thus it would be 
folly to treat the headache of uraemia and fail to treat the cause 
producing it. 

Not infrequently care is not taken to discover whether the 
patient lias sufficient sleep or rest. It is perfectly true that if a 
sick man lies awake an hour he is apt to believe he has been awake 
all night ; but, on the other hand, in severe illnesses prolonged actual 
wakefulness is a very exhausting feature of the attack. Every one of 
experience has seen cases rally when apparently in a most serious state, 
and convalesce!, when a good sleep has been given them by the aid of 

judiciously used drugs. If the patient is getting about the normal 
amount of sleep in the twenty-four hours, hypnotics should be as much 

avoided as if they were poisons. 



MODES OF ADMINISTERING DRUGS. 21 



MODES OP ACTION OP DRUGS. 

Drugs act in two ways, which are sometimes called near and 
remote, direct and indirect. The near, or direct, action of a drug is 
that influence which is felt by the exercise of its effects directly upon 
the tissues with which it comes in contact ; the indirect, or remote, 
influence is that result which comes as a sequence of its primary 
effect. As an illustration of this we may take the local use of can- 
tharides. The local, near, or direct effect of this is a blister ; the 
remote or indirect effect is the absorption of exudations or the influ- 
encing of inflammatory processes. If pilocarpine is used, its direct 
effect is the sweating which ensues, while its indirect effect is the 
relief of dropsy through the removal of exudation by the increased 
action of the skin, salivary glands, and kidneys. 

MODES OP ADMINISTERING DRUGS. 

Drugs may be administered for the purpose of affecting the gen- 
eral system in many ways, but practically we employ only eight 
methods, as follows : 

1. By the mouth or stomach ; 

2. By hypodermic injection; 

3. By inhalation ; 

4. By the rectum ; 

5. By inunction ; 

6. By fumigation ; 

7. By the endermic method. 

8. By kataphoresis. 

By far the most usual manner of administering drugs is by way 
of the mouth, which is the natural means of entrance into the body 
for foreign substances. Whenever medicines are used in this way 
the physician should clearly bear in mind what the medicine is to do 
after it is swallowed. Thus, if the drug is intended to act directly 
upon the stomach, it should not be given after meals, but some time 
before, since the food and gastric juice may afterward so cover the 
gastric mucous membrane that the medicament cannot act upon it. 
Thus, in a case of chronic gastric catarrh or gastric ulcer, the 
nitrate of silver which is used should always be given half an hour 
or an hour before meals. On the other hand, if an ulcer or other 
trouble exist in the small intestine, the pill should be given some time 
after meals, and, if a heavy meal is taken, three or four hours after, 
since under these circumstances the medicine is swept out into the 
intestine almost at once, without remaining any time in the stomach, 
where it may be chemically altered. Very often it is necessary to 
give a medicine soon after food is taken, in order that it may not 
act in too powerful or concentrated a manner upon the viscus which 
receives it or upon the general system by reason of its rapid absorp- 
tion in concentrated form. 

The general rule, however, may be laid down that all medicines 



22 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



are to be taken after rather than before meals, unless a local gastric 
effect or very rapid absorption is desired. 

Next to the use of drugs by the mouth, by far the most popular 
method is their administration by means of the hypodermic needle and 
syringe. The logic of this method rests upon the absorption of all 
soluble substances from the subcutaneous tissues with great rapidity. 
Any substance soluble enough or suspendable enough to pass through 
a hypodermic needle without forming an obstruction may be employed, 
provided it is not too irritating and that it is " clean." 

The proper places to give such injections are the forearm on the 
extensor surface, 1 the calf of the leg, the buttock, or the broad of the 
back — in other words, any spot where the tissues are not dense and 
unyielding. The skin of the part is to be grasped or pinched up 
with the thumb and forefinger of the left hand and the needle sent 
well into this raised fold, preferably above the finger and thumb, so 
that the pressure of the fingers may prevent pain and hold the part 
steady. The needle should always penetrate well into the loose con- 
nective tissue, so that the liquid injected may find lodgment in the re- 
laxed and spongy subcutaneous tissues without separating the skin from 

Fig. 1. 




Method of giving a hypodermic injection. The skin having been sterilized, the needle is 

then pushed into the subcutaneous tissues, as shown in tne illustration. If the injection 

en Into the forearm, the skin of the part into which the injection is to be given is to 

be raised bj grasping it between the thumb and fingers of the left hand to aid in holding 

the foreai m sti ady. 

it- rather close adhesion to the tissues below or from the blood-vessels 

supplying it. for if separation occurs abscess and a slough may result. 

The dangers from hypodermic injections are chiefly two. First: 

The needle may enter a vein, and the entire dose be carried at once, 

1 Hypodermic injections into the .'interior aspect of the forearm often cause much 
paio in tin hand by irritating temporarily the branches of the radial or ulnar nerves. 



MODES OF ADMINISTERING DRUGS. 23 

en masse, to the vital centres. Second : The solution or needle used 
may not be sterile, and an abscess result. The first danger is to be 
avoided by injecting into parts not well supplied with veins, and the 
second by thoroughly washing both syringe and needle with sterile 
water the instant before they are used, pushing a fine wire through 
the needle, and in some cases by soaking the instrument in carbolized 
oil. The solution injected should be prepared by using freshly boiled 
water and adding thereto carbolic acid in such proportion that one- 
half drop is present in each injection if a solution is to be permanent. 
It is claimed by some that this use of carbolic acid seriously hinders 
absorption, and in cases of urgency it should not be used. Most 
physicians now make a solution for immediate use by adding a small 
tablet of the required drug to 20 minims of water at the moment it is 
needed. A third danger supposed to exist by some persons, but prob- 
ably more feared than need be, is the injection of air into a vein with 
the medicament. It is well to see that all air is expelled from the 
syringe before making the injection. Most hypodermic syringes hold 
from twenty to thirty minims. 

When drugs are given by the rectum, we employ them for three 
purposes : First, to influence the general system by their absorption ; 
secondly, to act locally upon any disease which may be present in this 
particular locality or in the colon ; and, finally, to dislodge substances 
or parasites which it is desired to bring away. The word " enema " 
is loosely used to denote all these injections, be their purpose what 
they may, and is synonymous with "rectal injection" or the more 
old-fashioned word " clyster." If nourishment is being given, the 
injection is called a "nutrient enema." Sometimes these injections 
are called "lavements." 

In this mode of administration it is very necessary that the physi- 
cian should use his medicaments in proper bulk ; and it may be laid 
down as a rule that no more liquid should be injected than is neces- 
sary to convey the medicine or food, unless the injection is for the 
purpose of emptying the bowel of faecal matter or other materials, or 
it be desired to distend the bowel in order to overcome obstruction, or 
to influence the colon by drugs, 

The reason for this lies in the fact that any large bulk of liquid 
sent into the rectum so stimulates its walls by distention as to cause 
spasmodic contraction, with expulsion of all the rectal contents, which 
is just what is needed when faecal matter is to be removed, but the 
opposite of what is desired when retention of a remedy or food is 
necessary for absorption or local action. In rectal catarrh or ulcer 
two to four ounces of liquid are usually sufficient in an adult to 
accomplish any medicinal influence locally or by absorption, while as 
a laxative enema one to two pints may be employed. 

In the use of injections we frequently find that the rectum becomes 
irritable, and promptly resists all efforts to force the entrance of liquids 
or solids. This is to be avoided by giving the injection so gently that 
the bowel fails to recognize, as it were, the entrance of liquid, and by 
introducing a few drops of oil and laudanum in each injection. 



24 GENERAL THERAPEUTICAL CONSIDERATIONS. 

A large amount of distress often follows the gradual accumu- 
lation of faecal masses in the colon which are not passed with 
the daily movement of the lower bowel. These can readily be 
removed by large injections of warm water or by the use of medi- 
cated liquids. 

A very important use of injections by the rectum is in the treat- 
ment of the various causes of intestinal obstruction. Here the great- 
est caution should be exercised that the injection be made with all 
possible gentleness, and slowly, the liquid being allowed to dribble 
into the bowel rather than to force its way. It is dangerous to use a 
greater pressure than is given by a fountain syringe at the height of 
two or three feet, as rupture of the peritoneal coat of the bowel may 
occur. Where a large quantity of water is used it should be care- 
fully warmed to 100° or a little more, and it is well to add salt to it, 
so that it will represent the normal saline strength of blood-serum, 
namely, seven-tenths of one per cent. (For use of injections in 
special diseases see Part IV., and for Enteroclysis, Part III.) 

Suppositories are another means by which we introduce medicines 
into the bowel, either for local effect or to act after absorption of 
their contents upon the general system. 

When drugs are given by inhalation they are generally employed 
with the object of affecting the respiratory tract alone, although there 
are notable exceptions to this in ether, chloroform, nitrous oxide gas, 
and other volatile substances. Aside from anaesthetics, we find such 
remedial measures adopted as the inhaling of steam laden with the 
drugs employed, the respiring of air loaded with the fumes of the 
medicament, or the inhalation of gases, and last, and most commonly 
resorted to of all, the use of the vaporizer, which, if properly made 
and employed, so minutely divides the liquid containing the medicine 
that the inspired air carries it to the farthest bronchiole and pulmonary 
vesicle. (See Part III.) Atomized sprays have also been found to 
possess great penetrating power in the treatment of inflammations 
under the skin or mucous membranes, as, for example, boils and 
carbuncles. 

Aa an example of the rules governing the administration of drugs in 
this manner we find that compound tincture of benzoin may be taken 
by inhaling the steam arising from hot water containing it, but can- 
not be used in a spray because it occludes the fine points of the atom- 
izing tubes. In a similar manner we may inhale the smoke of bella- 
donna or tobacco-leaves to relieve asthma, or the fumes of chloride 
of ammonium for bronchitis in its later stages. Fumigation with 
mercury, the sublimed vapor being inhaled, is also useful. Finally, 
we find that oxygen is sometimes very useful, the gas being readily 
inhaled, with good results in proper cases. 

The " spray " or atomizer is made in two forms — one form of appa- 
ratus being worked through the agency of compressed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed-air atomizers throw a spray fine enough to reach the 
deeper parts of the Lungs, particularly if the air is compressed by the 
hand; hut all instrument-makers now sell vaporizers or nebulizers 



MODES OF ADMINISTERING DRUGS. 25 

which so minutely divide the liquid medicament that it enters the 
deeper parts of the lungs very readily. 

The inhalation of moist air is very useful in bronchitis, and 
greatly aids other remedial measures. Steam may be disengaged in 
a room by means of a kettle of boiling water or by placing pieces 
of unslaked lime in a pan of water. 

Inunctions consist in the rubbing into the skin of medicines gen- 
erally of an oily or fatty nature, or which assume this character 
through embodiment with oil or fat. The three substances most com- 
monly used in this way are cod-liver oil, mercurial ointment, and 
iodine ointment. They should always be applied on some part where 
the derm is thin and well supplied with subcutaneous lymphatics, as 
in the axillae, the groins, or the insides of the thighs. Other sub- 
stances have been and may be used by inunction ; but as this method 
is necessarily a disagreeable and dirty one, it is rarely resorted to 
unless the stomach is disordered or it is necessary to push the drug 
into the system by every possible avenue of entrance. 

The endermic method consists in the use of a blister, by means of 
which the epiderm is raised, when a little morphine or other alkaloid 
may be slipped under it and so absorbed through the true skin. It 
is a painful method, almost never to be resorted to, having been 
entirely supplanted by the hypodermic method of medication. 

Drugs are also sometimes caused to enter the body through the 
skin by placing them in plasters or poultices, or by the electrical 
process called cataphoresis. (Part III.) 

Remedies are administered in a number of forms, but chiefly as 
follows : 

Abstracts are dry powdered extracts mixed with sugar of milk 
.until they are twice as strong as the crude drug. Abstracts are no 
longer official in the United States Pharmacopoeia. 

Aceta, or vinegars, are solutions of the active principles of drugs 
in vinegar or dilute acetic acid. There are two in the United States 
Pharmacopoeia (Acetum Opii and Acetum Seillce) and three in the 
British (A cetumCantharidis, Acetum Ipecacuanhas, and Acetum Seillce). 

Alkaloids are organic bases, forming salts with acid radicals, gen- 
erally occurring in crystalline form and abstracted from crude drugs. 
They nearly always represent the active principle of the drug. 

Aqilss, or waters, are used as vehicles either for the dilution of 
strong medicines or for the purpose of carrying minute amounts of 
flavoring materials. 

Cataplasms are not official in the United States Pharmacopoeia. 
They are virtually poultices made of linseed-meal or of bread-crumbs. 

Cerates are ointments containing wax to render them harder than 
would ordinary fats. 

Charts, or papers, consist of bibulous paper soaked in a solution 
of the drug which they are meant to carry. 



26 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Confections are sometimes called electuaries or conserves, and are 
soft pastes which contain the drug mixed with sugar or honey. 

Decoctions are solutions of drugs made by boiling and then strain- 
ing while hot. 

Elixirs are diluted tinctures rendered pleasant to the taste by the 
addition of aromatic substances and sugar. 

Bmplastra, or plasters, are made up of adhesive substances placed 
upon a backing of cloth or leather and designed to adhere to the skin, 
being so applied for the purpose of holding a medicinal substance in 
contact with the body, of acting as a protective, or of aiding in the 
approximation of the edges of a wound. 

Emulsions are liquid preparations which consist of oily substances 
minutely subdivided and held in suspension usually by some gummy 
material mixed with water. 

Extracts consist of the soluble parts of plants reduced to a semi- 
solid or solid condition by evaporation ; the soluble constituents being 
taken from the plant by water or alcohol. 

Fluid Extracts are made in the same way as solid extracts, except 
that they are not so completely evaporated. 

Glycerita, or glycerites, are solutions of various substances in 
glycerin — the glycerin being used as a vehicle. 

Infusions are made by pouring boiling water on the crude drug 
and allowing it to stand for a short time until the water cools, after 
which the liquid is strained. Sometimes cold water is employed. 

Liniments are made of oily substances often mixed with powerful 
drugs to increase their efficiency. 

Liquors are usually watery solutions of non-volatile drugs. 

Mixtures are composed of two or more drugs or of a single drug 
partly dissolved and partly in suspension. 

Pills are small round masses which, as a general rule, should not 
weigh more than three grains, in order to avoid too great bulk. If 
the material is a heavy one, as much as five grains may be placed in 
each pill. Pills may be without covering or coated with sugar or 
gelatin to preserve them and prevent the patient from tasting their 
contents. Sugar-coated pills must always be fresh and the sugar- 
coating pure. Gelatin is the best coating for pills. Many pills are 
fraudulently coated with varnish and are insoluble. 

SPIRITS are alcoholic solutions of volatile substances. 

SUPPOSITORIES are small masses made into a cone shape and 
having for their basis cacao butter. They are designed to carry into 
the rectum certain medicines for absorption into the system or for local 
action. 

SYRUPS are solutions of sugar or gummy substances in water. 
They are used as vehicles. 

TABLETS.— Under this name manufacturing pharmacists and others 
prepare compressed pills or lozenges, generally of small size, the mass 
being made to adhere by means of its being subjected to great pressure 
by special machinery. Smaller tablets are used for carrying powerful 
drugs i^r hypodermic use. These, however, are often only lightly 
■ d, so as t<> render them easily soluble. 



DOSAGE. 27 

Tinctures are solutions of the active principles of drugs in alcohol 
or in mixtures of alcohol and water. 

Triturates are made by adding 10 per cent, of the active medi- 
cine to 90 per cent, of milk-sugar. These are then carefully rubbed 
together until the two are intimately mixed. Triturates are very val- 
uable in the administration of medicines to adults or to children. 
These triturates are often made into tablets, forming what are known 
as " Tablet Triturates." 

Troches, or lozenges, are flat, hardened masses designed for hold- 
ing medicines in the mouth, so that they may be slowly dissolved, 
thereby affecting the local mucous membrane 

Ointments, or unguents, consist of the mixture of some kind of 
fatty substance with the medicine which they are designed to carry. 

Wines are made in the same way as tinctures — strong white wine 
being used in the United States, and sherry or orange wine in Great 
Britain, in place of ordinary alcohol. 



DOSAGE. 

There is, unfortunately, no absolutely fixed rule which can be 
applied to dosage, for several reasons. In the first place, the indi- 
vidual may not be readily affected by drugs, or the disease-process 
which is present may so antagonize them as to render very large doses 
necessary. Further than this, the age and sex of a patient have much 
to do with the regulation of the proper amount of a drug which we 
may give. Finally, that curious but common condition of suscep- 
tibility to various remedies, that we call idiosyncrasy, creeps in as an 
important factor in the decision as to the dose which should be given 
in each case. By far the nearest approach which we can make to 
absolute accuracy in dosage is to use drugs according to the iveight of 
the patient, but this method possesses the disadvantages that we can- 
not always weigh our patients, and that the presence of a large amount 
of fat or of dropsy will make an unknown quantity in our calculation 
as to the true weight of the active part of the individual. 

At present we are accustomed to be governed by a list of doses to 
be given to all adults within certain limitations, and which are varied 
sufficiently to permit of great differences in the effects obtained. It 
is in this very point that the success of many a physician chiefly 
rests ; for the use of a dose by " rule of thumb " is as empirical and 
lacking in thought as is use of a remedy, not because we have a defi- 
nite action for it to carry out, but because it did some one else good 
who was suffering from what appears to have been a similar attack. 
The dose must be varied to fit the case in the same manner that the 
cut of a coat must be varied to fit each individual. 

There are a number of approximate rules in regard to the doses 
which are to be given in treating the diseases of children, the best of 
which is Young's rule. This is as follows : 

Add 12 to the age and divide by the age. Thus, if a child is two 
years old, we have the following formula : 2 -f- 12 = 14 -*- 2 = 7, or, 



28 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



one-seventh of the dose for an adult is the dose for a child of two 
years. This rule is not a law, however, for of narcotics children 
should receive less than this (one-half), and of purgatives or laxatives 
more than this (two or three times). 

When drugs are given hypoderruically the dose should be generally 
one-half to one-quarter of that given by the mouth ; and if any 
thought of idiosyncrasy exist, the dose should be smaller still at the 
start if powerful remedies are to be used. 

By the rectum the dose should be twice the amount given by the 
mouth, unless the drug be very powerful or capable of very rapid 
absorption. 

When ordering liquid medicines in small amounts we should always 
take pains to write for minims rather than drops, for the size of a 
drop varies with the particular liquid with which we are dealing and 
the shape of the mouth of the vessel containing it. This is well shown 
in the following table, compiled by Kinsey, and originally published 
in the American Journal of Pharmacy. 



Acetum lobeliae 

Aeetum opii 

Acetum sanguinarise . . . . 

Acid, acetic 

Acid, acetic, dilute 

Acid, carbolic 

Acid, hydrobromic 

Acid, hydrochloric 

Acid, hydrochloric, dil. . . 

Acid, nitric 

Acid, nitric, dilute 

Acid, nitrohydroehloric. . . 
Acid, nitrohydroehloric. di- 
lute 

Acid, phosphoric 

Acid, sulphuric 

Acid, sulphuric, dilute . . . 
Acid, sulphuric, aromatic. . 

Aqua ammoniae 

Aqua destillata 

Liquor potass, arsen 

oleum anisi 

Oleum amygdalae amar. . 

oleum can 

oleum chenopodii 

oleum earophylli 

oleum cinnamomi 

Oleum crotonia 

oleum cubebee 

oleum gaultheriae 

< ileum nedeomse 

Oleum Lavandulae 

oleum monardse 

oleum menl ha pip 

oleum menthee rtrldJ - . . 

oleum myristicse 

oleum origan] 

oleum pimento 

oleum rosmarlni 

oleum sassafras 



Dropped from 



51 
66 
102 
82 
94 
82 
57 
60 
70 
82 
63 
87 

58 
54 

160 
57 
97 
45 
64 
58 
76 

102 

108 
94 
98 
77 
84 
86 
93 
95 

105 
82 
88 
95 
98 
91 

102 
'.12 



74 

54 
43 
152 
47 
94 
41 

*61 
73 
77 
84 
75 
75 
73 
62 
80 
93 
83 
78 
76 
7:5 
81 
s:* 
88 



77 



S* 



sa 



64 
65 
92 

101 
99 

110 
70 
96 
62 

124 
81 
92 

62 

62 

172 

60 

144 

54 

61 

77 

112 

75 

133 

129 

133 

112 

104 

120 

136 

130 

133 

125 

132 

132 

128 

188 

188 

133 

142 



Oleum tanaccti . . . 
Oleum terebinthinae . 
Spiritus ammon. ar. . 
Spiritus camphorae . 
Spiritus aether, comp. 
Spiritus aether, nitr. . 
Spiritus menthse pip. 
Syrupus scillae comp. 
Tinctura aconiti . . 
Tinctura asafcetidae . 
Tinctura belladonnae 
Tinctura benzoini co. 
Tinctura cannabis ind 
Tinctura cantharidis 
Tinctura capsici . . . 
Tinctura colchici . . 
Tinctura digitalis . . 
Tinctura ferri chlor. 
Tinctura hyoscyami 
Tinctura ignatiae . . 
Tinctura iodi .... 
Tinctura kino .... 
Tinctura krameriae . 
Tinctura lavand. co. 
Tinctura lobeliae . . 
Tinctura myrrhae . . 
Tinctura niicis vomicae 
Tinctura opii .... 
Tinctura opii camph. 
Tinctura opii deodor. 
Tinctura rhei .... 
Tinctura sanguinariae 
Tinctura stramonii . 
Tinctura tolutani . . 
Tinctura vcratri virid 
Vinum aloes ... 
Vinum colchici rad. . 
Vinum colchici sem. 
Vinum ergotse .... 
Vinum opii .... 



Dropped from 



2^ 
■a o 

CO.Q 



110 
103 
108 
98 
120 



106 

120 

102 

94 

98 

124 

118 

116 

86 

114 

108 

114 

112 

112 

116 

117 

97 

110 

100 

112 

98 

94 

109 

98 

110 

100 

120 

108 

71 

92 

86 

148 

96 



91 



87 
102 
85 
81 
81 
120 
97 



79 

'91 

83 
97 

100 



79 
95 
105 
92 
86 
89 
82 
88 
93 
97 
98 
54 
72 
71 
99 
72 



S3 



136 
142 
139 
140 
140 
144 
143 
122 
164 
145 
128 
146 
98 
136 
143 
124 
145 
139 
147 
140 
144 
148 
150 
141 
138 
145 
148 
143 
135 
141 
144 
134 
120 
156 
152 
94 
95 
105 
122 
102 



Doses are also ordered in teaspoonful, dessertspoonful, and table- 
poonful quantities. Sometimes they are given by the wineglassful, 



WEIGHTS AND MEASURES. 



29 



meaning by this term a sherry-glassful. Roughly estimated, a tea- 
spoonful equals a fluidrachm (4.0), a dessertspoonful two fluidrachms 
(8.0), and a tablespoonful half a fluidounce (15.5). As spoons and 



Fig. 2. 



Fig. 3. 





Graduated medicine glasses. 



Fig. 4. 




wineglasses vary considerably in capacity, it is always best to use a 
graduated medicine glass, such as are shown in Figs. 2, 3, and 4. 



WEIGHTS AND MEASURES. 

There are two systems of weights and measures employed in the 
United States at the present time. The one most commonly employed 
is the old-fashioned system of Apothecary weights for solids, and the 
Wine, or Apothecary, measures for liquids. The newer and more 
accurate system is that which is known as the Metric, or Decimal, 
system of weights and measures, and it is now recognized and recom- 
mended by the Pharmacopoeias of the United States, Great Britain, 
Germany, and France. 

The divisions of Apothecary weights are the pound, the ounce, 
the drachm, the scruple, and the grain. The scruple, which equals 
20 grains, has dropped out of use, chiefly because the scruple mark 
when it is written somewhat resembles that of the drachm. We 
may say, therefore, that the Apothecary weights consist of a pound, 
equalling 12 ounces, or 96 drachms, or 5760 grains ; that the ounce 
represents 8 drachms, or 480 grains ; and that the drachm equals 60 
grains. The abbreviation for the word grain is "gr."; for the drachm, 
3; for the ounce, ^; and the pound, lb. 

In the Wine, or Apothecary, measure we have the gallon, the pint, 
the fluidounce, the fluidrachm, and the minim. In each gallon there 
are 8 pints, 128 fluidounces, 1024 fluidrachms, and 61,440 minims. 
In each pint there are 16 fluidounces, 128 fluidrachms, and 7680 
minims. In each ounce there are 8 fluidrachms and 480 minims. In 
each drachm there are 60 minims. The abbreviation of the Latin 
word " minimum " or " minim " is Kit ; of the fluidrachm, f£ ; of the 
fluidounce, f ^ ; of a pint, or " octarius, u O" ; and of the gallon, or 
congius, " Cong." 



30 GENERAL THERAPEUTICAL CONSIDERATIONS. 

The British Pharmacopoeia has adopted the Avoirdupois system 
of weights, and thereby has a system which differs somewhat from 
the Apothecary weights of the United States Pharmacopoeia. 
The Avoirdupois pound represents 16 ounces, or 7000 grains ; the 
Avoirdupois ounce, 437.5 grains. It will be seen, therefore, that the 
Apothecary pound contains 1240 grains less than the Avoirdupois 
pound, but that the Apothecary ounce contains 42-J- grains more than 
the Avoirdupois ounce. Fortunately, however, the grain, both of the 
Apothecary and Avoirdupois systems, is of identical value. So, too, 
the British Pharmacopoeia uses what is known as the Imperial system 
of measures in place of the Wine measures used in the United States. 
Thus, the Imperial gallon represents 8 pints, 160 fluidounces, 1280 
fluidrachms, and 76,800 minims; the Imperial pint, 20 fluidounces, 160 
fluidrachms, and 9600 minims ; and the fluidounce, 8 drachms or 480 
minims. The fluidrachm equals 60 minims. It will be seen, there- 
fore, that the Imperial measure differs from the Wine measure chiefly 
in having 20 fluidounces in each pint, instead of 16. So, too, the 
weight of the Imperial fluidounce contains the same number of 
grains as the Avoirdupois ounce, which is 18.2 grains less than the 
weight of the United States fluidounce, which is 455.7. These differ- 
ences between the weights and measures used in the United States and 
Great Britain are, therefore, of little importance when we are employ- 
ing grains or minims, but they become of great importance when we 
employ ounces, and of still greater importance when we employ pounds 
or pints. In the average prescription, however, w r hich rarely exceeds 
three or four ounces, the difference in quantities in the United States 
and Great Britain are not of very great importance. 

The advantages of the metric system over these irregular systems 
of weights and measures are the same as those of the decimal system 
of currency over the English system of pounds, shillings, and pence. 
The unit of all calculations is the metre, which in the metric system 
is the unit of length. From this is derived the unit of capacity, 
the litre, which is the cube of one-tenth of a metre; and from the 
litre is derived the unit of weight, the gramme, which is the one- 
thousandth part of the weight of a litre of distilled water at its maxi- 
mum density. As a matter of fact, the metric system is no more 
difficult to master than is the system of dollars and cents. The great 
difficulty is that the majority of physicians having learned the doses 
of various preparations in the Apothecary weight find it difficult to 
begin using the metric system, and do not take the trouble to convert 
the Apothecary doses into this system. 

In the metric system we have the gramme, which may be said to be 
the equivalenl of the dollar; the decigramme, or one-tenth of a gramme, 
which represents the dime; the centigramme, or one-hundredth of a 
gramme, which represents the cent; the milligramme, or the one- 
thousandth of ;i gramme, which represents the mill. Above the 
gramme in quantity we use what is known as the Dekagrammc, which 
corresponds to the gold eagle, or ten dollars; the Hectogramme, which 
corresponds to one hundred dollars; and the Kilogramme, which 
corresponds to one thousand dollars. 



WEIGHTS AND MEASURES. 31 

When we come to the use of the metric system for fluids, we use as 
the unit the cubic centimetre (cc.) in place of the gramme ; a cubic 
centimetre representing 1 fluid gramme. 

When it is wished to convert grains into their metric equivalent, 
it must be remembered that 0.065, or 6b milligrammes, is the equiva- 
lent of 1 grain. Therefore, the following examples may be used : 

3 grains are equal to 3 X 0.065 = 0.195 gramme. 

60 grains " " " 60 X 0.065 = 3.9 grammes. 1 

\ grain is " " \ of 0.065 — 0.0162 gramme. 

to o g rain is " " rfo of 0.0065 = 0.00065 gramme. 

To convert grammes into grains, instead of multiplying by 0.065, 
we divide, thus : 



Gramme 0.12 is equal to 0.12 


- 0.065 = 


1.8 grains. 


Grammes 3.9 are " " 3.9 


- 0.065 = 


60 grains 


Gramme 0.06 is " " 0.06 - 


- 0.065 = 


0.9 grains. 


Gramme 0.0006 " " " 0.0006 - 


- 0.065 = 


0.0092 grain. 



When we wish to convert apothecaries' drachms into grammes, we 
multiply the number of drachms by 3.9, or more commonly, though 
less accurately, by 4.0. Thus: 

10 drachms X 4 =40 grammes, or, more accurately, 
10 drachms X 3.9 = 39 grammes. 

When grammes are to be converted into drachms, we divide the 
number of grammes by 3.9, or approximately 4.0. Thus : 

10 grammes -*- 3.9 — 2.56 drachms, or, less accurately, 
10 grammes -^ 4. = 2.5 drachms. 

When Apothecary ounces are converted, we multiply by 31.1 ; 
or, if grammes are to be converted into ounces, we divide by 31.1. 
Thus: 

2 ounces X by 31.1 = 62.2 grammes. 
40 grammes -*- by 31.1 = 1.25 ounces. 

As accurate translation of apothecaries' weights into the metric 
system leaves a fractional quantity in almost every instance, and as 
the translation of the metric system into apothecaries' weights does 
likewise, the author has for the sake of presenting even figures, and 
therefore rendering the interchange practicable, considered that the 
Apothecary ounce and the fluid ounce are equal to 30 grains or 30 
minims, although a more accurate estimate is 31.1. 

1 Usually considered 4.0. 



32 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



TABLES OF RELATIVE WEIGHTS AND MEASURES IN THE 
METRIC AND APOTHECARIES' SYSTEMS. 

(See Oldberg's Manual of Weights and Measures.) 







Milligrammes 


in Grains. 






Milligramme. 


Grain. 


Milligrammes. 


Grain. 


Milligrammes. 


Grain 


0.1 


= 


6"oo 


1 


= 


l 

60" 


8 


=== 


1 

8 


0.2 


= 


"5W 


1.2 


= 


1 
TO" 


9 


= 


1 
7 


0.3 


= 


TOO 


1.6 


= 


• A 


10 


= 


1 
6 


0.4 


= 


T50 


2 


= 


1 
So" 


12 


= 


1 

5 


0.5 


= 


1 
TTO" 


3 


= 


A 


16 


= 


1 
4 


0.6 


= 


1 
TOO 


4 


= 


i 

T5" 


20 


= 


i 


0.7 


= 


ik 


5 


= 


A 


30 


= 


\ 


0.8 


= 


A 


6 


= 


i 

TO 


60 


= 


1 


0.9 


= 


1 
TO" 


7 


= 


9 












( 


Centigrammes 


in Grain 


s. 






Centigrammes 
(or Cent.) 


Grain. 


Centigrammes, 
(or Cent.) 


Grains. 


Centigrammes 
(or Cent.) 


Grains 


1 


= 


* 


6 


= 


1 


18 


— 


3 


2 


= 


l 
"3" 


7 


= 


1* 


25 


== 


4 


3 


= 


\ 


9 


= 


H 


50 


= 


8 


4 


= 


2 


10 


= 


if 


75 


= 


12 


5 


= 


f 


12 


= 


2 


100 


= 


16 








Grammes in 


Grains. 








Grammes. 




Grains. 


Grammes. 




Grains. 


Grammes. 




Grains. 


0.001 


= 


l 
6"o" 


11 


= 


176 


27 


— 


432 


0.010 


= 


l 
B" 


12 


= 


192 


28 


—5 


448 


0.100 


= 


1 2 


13 


= 


208 


29 


— 


464 


0.250 


= 


4 


14 


= 


224 


30 


S- 


480 


0.500 


= 


8 


15 


= 


240 


31 


— 


496 


0.750 


= 


12 


16 


= 


256 


32 


— 


512 


1 


= 


16 


17 


= 


272 


33 


-- 


528 


1.50 


= 


24 


18 


= 


288 


34 


— 


544 


2 


= 


32 


19 


= 


304 


35 


— 


560 


3 


= 


48 


20 


= 


320 


36 


— 


576 


4 


= 


64 


21 


= 


336 


37 


— 


592 


5 


= 


80 


22 


= 


352 


38 


ss 


608 


6 


= 


06 


23 


= 


368 


39 


— 


624 


7 


= 


112 


24 


= 


384 


40 


— 


640 


8 


= 


128 


25 


— 


400 


50 


= 


800 


9 


= 


144 


26 


= 


416 


100 


= 


1600 


10 


= 


L60 















ABSORPTION OF DRUGS. 



33 



Cubic Centimetres (or Fluidgrammes) in U. S. Apothecaries' 

Fluidrachms. 



Cubic 




U.S. 


Cubic 




U.S. 


Cubic 




U.S. 


Centimetres 




Fluidrachms. 


Centimetres 




Fluidrachms. 


Centimetres 




Fluidrachms. 


1 


= 


l 

4 


9 


= 


2i 


16 


= 


4 


2 


= 


1 
2 


10 


= 


2| 


20 


= 


5 


3 


= 


3 

4 


11 


= 


^4 


24 


= 


6 


4 


= 


1 


12 


= 


3 


28 


= 


7 


5 


= 


1-4- 


13 


= 


8i 


32 


= 


8 


6 


= 


14 


14 


= 


3J 


48 


= 


12 


7 


= 


If 


15 


= 


3| 


64 


= 


16 


8 


= 


2 















ABSORPTION OF DRUGS. 

The knowledge of the rapidity with which certain drugs are absorbed 
from the various surfaces with which they come in contact is of 
importance in order that we may know when to repeat the dose if 
the first amount does not produce the desired effect. The rapidity 
of absorption depends upon a number of factors. If the circulation 
is active, absorption is active, but if it be depressed, absorption is slow. 
Thus, in a person apparently drowned, absorption may not occur at 
all until the vital functions are restored, and repeated doses given to 
the patient while unconscious, acting together, in the end poison him. 
This is often the case in delirium tremens where hypodermic injec- 
tions of morphine are given or when the drug is administered by 
the mouth. In dropsy absorption is peculiarly slow, and the drug 
may remain in the tissues for days, only to be absorbed with the exu- 
dation after severe purgation or profuse diuresis, or tapping. In 
general dropsies hypodermic medication is nearly always worse than 
useless. 

When the stomach or bowel is empty absorption from either is 
rapid, but when they are full it is very slow. In this fact we find the 
reason for the popular idea that a glass of whiskey when a man is 
hungry makes him drunk, whereas twice the quantity after dinner 
does not do so. 

Drugs in the stomach or bowel have no influence over the general 
system unless they are irritants. They only act when taken into the 
blood or lymphatics. 

Recent studies show that alcoholic solutions of drugs are more 
rapidly absorbed than are watery solutions or those made with gly- 
cerin or milk. 

When the stomach is depressed and its powers of absorption im- 
paired, the addition of some irritant or stimulant, such as capsicum, 
will often aid in the absorption of an important drug. 

DURATION OF ACTION OF DRUGS. 

The duration of the action of drugs depends partly upon their 
rapidity of absorption, but chiefly upon the rapidity or slowness of 
their destruction in the body or their elimination from it. Thus, 



34 GENERAL THERAPEUTICAL CONSIDERATIONS. 

volatile substances, such as ether, chloroform, and nitrite of amyl, act 
only for a short time and are quickly eliminated, whereas bromide of 
potassium and digitalis continue active during many hours, and are 
slowly eliminated, as in the case of the former, or oxidized, as in that 
of the latter. Again, if curare is given hypodermically it will cause 
paralysis, but if taken by the stomach in moderate amount it will be 
eliminated by the kidneys as rapidiy as it is absorbed, and produce 
no eifects if these organs are active. 

From studying the rapidity of the elimination of a drug we learn 
how often to order a dose. Thus, digitalis may be given once, twice, 
or thrice a day, but carbonate of ammonium every two or three hours. 

When the physician is not careful in the use of a drug which is 
eliminated slowly, it may suddenly develop so severe an effect as to 
cause alarm, owing to the accumulation of the poison in the body. 
This is called "cumulative action." 



COMBINATION OF DRUGS FOR JOINT EFFECT. 

The study of the physiological action of drugs has aided us very 
greatly in improving our therapeutic measures. Thus, we now know 
that chloral is a heart-depressant and cannot be used in very full 
doses, or pushed to produce sleep in persistent insomnia, without 
grave danger ; whereas morphine, which also produces sleep, but does 
not depress the heart, but does depress the respiration, can be com- 
bined with it, and the two acting together, each in small dose, pro- 
duce a heavy sleep, although so little chloral is present that the heart 
is safe, and so small an amount of morphine is used that the respira- 
tion does not suffer. 

Another example of this is found in certain purgative pills where 
the purgative agent is assisted by belladonna and mix vomica, the first 
of which relaxes muscular spasm, while the second acts as a tonic to 
the alimentary tract, the drugs combining to accomplish one result. 

Skill in the combination of drugs, not only for increased physio- 
logical effect, but also for the purpose of making their administration 
pleasant to the taste, has much more to do with professional success 
than is generally supposed. This is particularly so -in regard to 
children, for parents dislike forcing their children to take doses 
which they themselves regard as horrible, and they are ever ready to 
believe thai as long as a medicine tastes good it is better than one 
which tastes otherwise. 

The medical practitioner who prescribes never so wisely and appro- 
priately for a patient, but who is utterly regardless as to his combina- 
tion- of drugs so far as taste is concerned, will sooner or later see a 
more ignorant man take from him that practice which his greater 
wisdom entitles him to, but which is driven from him by his own 
errors in this matter. 

While in some eases there is no alternative but to give a bad dose, 
in others a little thought and care will often avoid offending the taste 

>f the patient. 



STRENGTH AND RELIABILITY OF DRUGS. 35 

STRENGTH AND RELIABILITY OP DRUGS. 

If a census could be made of those who die annually from the use 
of drugs which are impure or useless from weakness, the writer 
believes that a most alarming array of figures would be presented. 
For many years this was unavoidable to a great degree, either because 
our knowledge of the active principles of drugs and the methods of 
isolating them was deficient, or because the time consumed in their 
transportation by sailing vessels or on the backs of natives from the 
countries in which the natural products yielding the drugs were 
obtained, permitted deterioration to take place. At present these 
difficulties have been largely overcome. The trained pharmacist is 
taught how to make an assay for active principles in most of the valu- 
able alkaloidal drugs, and every physician should make careful inves- 
tigation into the quality of all preparations which he employs. That 
these remarks are not out of place will be seen by the fact that not 
long since an intimate friend of the writer bought from five of the lead- 
ing druggists of Philadelphia six ounces of tincture of mix vomica 
which were stated to have been made according to the directions of 
the United States Pharmacopoeia. That made by perhaps the leading 
druggist of the five contained twice as much strychnine and brucine 
as it should, and had twice as much solid residue ; or, in other words, 
a physician prescribing this tincture in full dose would probably have 
poisoned his patient and reported the case as one of unusual suscepti- 
bility to drugs ! On the other hand, the author has recently seen a 
tincture of nux vomica which contained only a trace of alkaloid, 
but had much inert solid residue. In neither instance was the drug- 
gist dishonest intentionally, but one had used a crude drug which 
was unusually rich in alkaloids, while the other had purchased nux 
vomica beans which, by reason of immaturity, bad surroundings, or 
exposure to weather, were very poor in active principles. All these 
disadvantages may be avoided if physicians will insist that the drug- 
gists who dispense the drugs they order shall either themselves pre- 
pare assayed products, or purchase such products from any one of the 
large manufacturing chemists who put assayed goods on the market. 
When this is impossible, the physician should employ the alkaloids 
in pill form, or, if solutions are desirable, the alkaloid may be added 
to alcohol or water and given by drops, as is the case with any ordinary 
tincture. Digitalis, veratrum viride, and ergot are practically the only 
drugs of importance of which an assay cannot be made ; in the first and 
third the action of the drug does not depend upon a single active prin- 
ciple, but upon a number difficult of assay, and in the second the rela- 
tive proportions of jervine and veratroidine cannot be well estimated. 
All drugs should be physiologically tested when their chemical assay 
is impossible. Not long since several thousand pounds of ergot were 
found on being tested physiologically by one firm to be worthless ; but 
it was put on the market nevertheless, for certain manufacturers do not 
employ this method of examination. Constant uncertainty is a danger- 
ous element when we are dealing with patients who are desperately ill ; 
and in many cases failure and discouragement may both be avoided 



36 GENERAL THERAPEUTICAL CONSIDERATIONS. 

if the physician will see to it that the drugs which he administers are 
in good order and capable of doing what he requires of them. A 
poor drug to the physician is worse than a rusty knife to the surgeon ; 
for the injury in the one case is unknown, while in the other it can be 
carefully watched and guarded. 



IDIOSYNCRASY. 

This is one of the most interesting features of the study of the 
action of drugs. It is a frequent cause of disappointment to both 
patient and doctor, and an equally frequent cause of excessive action 
from what the physician has thought to be a moderate dose. No rule 
can be laid down for the discovery of idiosyncrasy in a given case, 
except that females, particularly of the hysterical type, are more 
subject to it than are males, although certain men often present marked 
evidences of this tendency. No better illustration of idiosyncrasy can 
be adduced than the case which here follows, nor than that of a friend 
of the author who cannot eat a strawberry without suffering from a 
violent attack of hives. 

The first case is that of a woman of thirty years, suffering from 
severe headache, who received an eighth of a grain of the hydro- 
chlorate of pilocarpine, hypodermically, every twenty minutes, until 
nearly three-fourths of a grain was taken, without any evidence of its 
action either in salivary flow or sweat. But the tolerance of drugs 
did not stop here. Twenty drops of tincture of cannabis indica every 
four hours failing to relieve the pain, half-grain pills of the solid 
extract were ordered, two of which commonly affect a grown man 
most markedly. The extract had been proved to be active to other 
patients. In order to avoid any failure in absorption the pills were 
each cut in half before they were given, and forthwith administered, 
one every three hours, without any effect after ten had been taken. 
Twenty more of the pills from the same manufacturers, but from a 
different retailer, were now given, one every hour with the exception 
of a few irregularities in administration during the night, the entire 
twenty being swallowed between four o'clock one afternoon and two 
o'clock in the next afternoon. The thirty pills (fifteen grains) were 
taken in loss than forty-eight hours without producing a single physio- 
logical sign of the slightest character. That the doses were really 
swallowed would scorn to be undoubted, for their administration was 
carried out by a trained attendant, and their black color forbade their 
expulsion from the mouth on the bed without attracting attention. 
'Ho- hypodermic injections were given by the author, and. as the solu- 
tion vraa used a- fast as it was made, the patient must certainly have 
received all of the pilocarpine. 

Aj there was daily an afternoon rise of temperature amounting to 

pal degrees, quinine bisulphate was ordered in the dose of fifteen 
grains, t<> be given after six powders of one-sixth of a grain of calomel 
had horn taken: tin- nm only failed to control the fever, but also 
produced no buzzing in the ears. The writer was now inclined to 



INDICATIONS, CONTRAINDICATIONS, AND DEFINITIONS 37 

consider all the symptoms as hysterical, even including the evening 
rise of temperature. 

Twenty-four hours after the last dose of cannabis indica the attend- 
ant gave the patient, without orders, no less than sixty grains of anti- 
pyrin in sixteen hours without any physiological symptoms, and, under 
orders, she took from forty to fifty grains of bisulphate of quinine every 
day for three days without any signs of cinchonism. 

Wide experience has taught us, however, that several conditions 
act fairly constantly in regard to some idiosyncrasies. Certain dis- 
eased conditions — such as peritonitis or pain — allow large doses of 
opium to be given, and in lead-poisoning and paralysis patients may 
require enormous doses of active purgatives to move the bowels. 

The climate in which the patient lives, or has been accustomed to 
live, renders him more or less susceptible to certain remedies. Thus 
the East Indian runs amuck after eating hasheesh or cannabis indica, 
or the Chinaman goes into a delightful dreamland from smoking 
opium, whereas the Anglo-Saxon experiences no such agreeable sen- 
sations, as a general rule. Southerners generally require larger 
doses of purgatives than Northerners, often because their livers are 
not as active. 

The temperament of an individual is also a highly important matter 
to be considered. It is a notorious fact that phlegmatic dark-skinned 
individuals usually yield to drugs less readily than blondes and nervous 
persons, more especially in respect to the drugs which act on the ner- 
vous system. Nervous light-haired women stand belladonna very 
badly as a general rule, while children will take large doses often 
without discomfort. Opium is usually badly borne by children. 

Habit is another important factor governing idiosyncrasy. We all 
know how rapidly one becomes accustomed to tobacco, and how mor- 
phine habitues take enormous amounts of their favorite drug without 
effect. 



INDICATIONS AND CONTRAINDICATIONS AND 
DEFINITIONS. 

The indication for a drug is any symptom or series of symptoms 
which we know the drug will relieve without causing at the same 
time an evil effect to be felt by other parts of the body. A contra- 
indication is any coexisting state or tendency which will be made so 
much worse by the drug as to forbid its use. Thus, one might be 
tempted to give quinine in meningitis for the fever, yet this would 
be bad therapeutics, since quinine is contraindicated because it will 
intensify the meningitis. 

Abortifacients form a class of drugs which, as such, ought never to 
be employed. If pregnancy is to be interfered with, the interruption 
should be produced by instrumental means, and then only after con- 
sultation with another practitioner to get his views and protect one's 
self from possible legal difficulties. 



38 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Alteratives are indicated where cell-growth is active to excess, but 
contraindicated where tissue break-down is present, or there exists a 
tendency thereto. 

Anesthetics are drugs used to produce lack of sensation. They 
are either local or general. Many of the local anaesthetics produce 
loss of sensation through benumbing the parts by the cold they pro- 
duce. Cocaine is an example of a local anaesthetic which causes 
anaesthesia by a direct paralyzant action on the peripheral sensory 
nerves. The general anaesthetics are taken by inhalation and act 
upon the higher centres in the brain. 

Anaphrodisiacs are remedies used to diminish sexual desire. 

Antacids are employed in cases where, as a result of morbid pro- 
cesses, lactic and butyric acids, or even hydrochloric acid, are found 
in abnormal quantities in the stomach. 

Anthelmintics are those remedies which are used for the purpose 
of removing intestinal worms. 

Antiarthrities is the name given those drugs which are employed 
for the purpose of relieving inflammations occurring in joints, whether 
these be in an acute or chronic condition of disease. 

Antihydrotics are used to prevent excessive sweating, either when 
it is local or general. Camphoric acid is probably the best general 
antihydrotic. 

Antiperiodics is a term applied to drugs or remedies employed for 
the prevention or cure of malarial poisoning. They are so named 
because they tend to break up the periodicity of the attacks, which 
periodicity is a characteristic of such diseases. 

Antiphlogisties are remedies employed to prevent the progress of 
inflammatory processes. They are nearly all contraindicated in the 
presence of tissues possessing an impaired vitality through previous 
conditions of disease. 

Aphrodisiacs are remedies used to increase sexual desire and 
power. 

Astringents are employed for the purpose of contracting or con- 
stringing tissues. They act either by coagulation of albumin, by pre- 
cipitating albumin, or by making the tissues more dense by con- 
centration. Theoretically, all astringents should be non-irritating, 
bnt practically they possess irritant properties, and are, in conse- 
quence, contraindicated in the presence of very acute inflammations as 
a rule. Three of the mineral astringents, however, possess marked 
Bedative properties in addition to their astringent power, and can 
therefore he used freely in acute inflammations when locally applied. 
They are nitrate of silver, subacetate or acetate of lead, and the sub- 
carbonate or subnitrate of bismuth. 

Bitters are remedies designed to increase the activity of the 
mucous membrane of the gastro-intestinal canal by increasing its 
tone. They may be divided into simple bitters and complex bitters. 
The first depend upon their bitterness solely for their activity; the 
ud class is we\] represented by quinine or strychnine, both of 
which are exceedingly hitter, but, in addition to their local effect on 
the gastro-intestinal mucous membrane, act as stimulants to other por- 



INDICATIONS, CONTRAINDICATIONS, AND DEFINITIONS. 39 

tions of the organism. A good example of a simple bitter is columbo. 
Many bitters contain so much tannic acid that they are not generally 
useful, and for this reason very few can be used with preparations of 
iron, since a tannate of iron would be formed. 

Cardiac sedatives are drugs which decrease the force of the heart, 
and, as a class, the amount of blood expelled at each beat of the ven- 
tricles. They are indicated in arterial excitement, contraindicated 
in arterial depression. 

Cardiac stimulants are drugs which increase the force of the heart, 
thereby increasing the quantity of blood expelled from the ventricles. 
This may be accomplished by an increase in the rapidity of the beats 
or by a greater output of blood at each contraction, the diastole being 
sufficiently prolonged to admit of the ventricles being well filled. 
They are contraindicated in the presence of arterial excitement, and 
indicated in arterial depression. 

Carminatives are remedies given for the purpose of expelling flatus, 
particularly if there is reason to believe that the " wind " has accu- 
mulated because of intestinal torpidity. Many of the carminatives 
are necessarily possessed of irritant properties, and are therefore con- 
traindicated in the presence of flatulence due to intestinal atony aris- 
ing from inflammation. The best carminative is spiritus aetheris com- 
positus, or Hoffmann's xlnodyne. 

Cathartics. — These are drugs employed when a positive and 
decided action of the bowels is desired. They occupy a position 
between the purges and the drastics. (See Purges and Drastics.) 
A good example of a cathartic is senna when given in full dose. 

Cholagogues are used to exert a stimulant influence over the flow of 
bile. Nitro-hydrochloric acid and mercury bichloride are perhaps 
the best types of pure cholagogues, while podophyllum and calomel 
represent the class of cholagogues which increase intestinal peristalsis 
in addition to stimulating the flow of bile. Cholagogues are, as a rule, 
contraindicated in the presence of acute inflammation of the gall- 
bladder or liver. 

Counter-irritants are remedies used to produce irritation at a spot 
distant from a painful or inflamed area, in order to relieve the diseased 
parts by reflex action exerted through the nervous system upon the 
painful nerve or disordered capillary network. 

Demulcents are substances used to protect any exposed parts of 
the body from irritation. 

Diaphoretics produce an increased secretion from the sweat-glands. 
They may be considered as internal and external. The internal are 
represented by pilocarpine, which stimulates the sweat-glands them- 
selves ; the external are represented by the Turkish and Russian 
baths, which, by increasing bodily heat and dilating blood-vessels, 
cause a profuse sweat. 

Diuretics are used to increase the flow of urine from the kidneys. 
They act by stimulating the renal epithelium to greater activity, 
thereby increasing the excretion of both the watery and solid con- 
stituents of the urine ; or they simply increase the watery constituents 
by increased blood-pressure in the kidney. 



40 GENERAL THERAPEUTICAL CONSIDERATIONS. 

It is to be remembered that the vegetable salts of potassium and 
the lithium salts increase the solids in the urine, not by stimulating 
the secreting epithelium of the kidney, but by uniting with insoluble 
material in the system, forming soluble compounds which are then 
readily eliminated. (See Eliminators.) They are indicated in con- 
ditions of renal inactivity due either to functional or organic causes. 
Irritating diuretics, such as cantharides, for example, are contraindi- 
cated in acute nephritis. Such a diuretic is only to be used where 
the kidneys are inactive through atony or prolonged chronic or sub- 
acute disease. 

Eliminators are drugs which, by forming soluble compounds with 
insoluble substances in the body, render them capable of being ex- 
creted by the excretory organs, such as the skin, kidneys, and bowels. 

Emetics are drugs used to produce vomiting. They act centrally 
when, as is the case with apomorphine, they stimulate the vomiting 
centre, peripherally when they irritate the walls of the stomach. 
They are indicated when we wish to unload the stomach of unde- 
sirable materials, or when we desire to cause an increased flow of 
bile from the gall-bladder, which is accomplished by the pressure 
exerted upon this viscus when the abdominal walls and diaphragm 
contract in retching. When the ducts are mechanically obstructed 
by a gall-stone emetics are dangerous, as they may cause rupture 
of the gall-bladder. 

Sometimes we are able by the use of emetics to rid the lungs and 
stomach of mucus in bronchitis or gastric catarrh. 

The contraindications to emetics are cerebral congestion or menin- 
gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia. 

Emmenagogues are remedies used to produce or increase the men- 
strual flow. They are of two classes — direct and indirect. The direct 
are most of them irritants, and are seldom of much value ; the indirect 
are used to overcome the morbid condition underlying the menstrual 
disorder, and are therefore more rational. Thus iron and arsenic may 
be used with beneficial result in amenorrhosa due to anaemia. 

Expectorants are employed when it is desirable to promote secretion 
or to get rid of secretion in the bronchial tubes. Thus, in the early 
stages of an acute bronchitis the mucous membrane is hyperaemic 
and swollen, but dry and irritable. Ipecac and citrate of potassium 
form at this time a sedative expectorant mixture, which, while allay- 
in <_: irritation, promotes secretion, and so relieves the engorged area. 
On the other hand, after the acute stage is passed, there may be so 
much atony of the mucous glands that the secretion is either too 
scanty or too viscid to be coughed up. Stimulant expectorants, such 
as chloride of ammonium, eucalyptus, and terebene, are now to be 
employed. These latter drugs are contraindicated in the acute inflam- 
matory stage of the disease, as they would simply stimulate the irri- 
tated mucous membrane to greater irritation. 

Hypnotics are drugs used to produce sleep. They may be divided 
into those which produce sleep and relieve pain, and those which have 
no analgesic power. The hitter are therefore not to be employed in 

plessness due to pain, and the former are contraindicated when 



INCOMPATIBILITY. 41 

pain is absent. Thus, chloral produces sleep if it be ordinary func- 
tional insomnia ; but if the sleeplessness is due to pain, opium is the 
drug to be employed. Chloral, in ordinary doses, is the purest hyp- 
notic that we have. 

Mydriatics are drugs which produce dilatation of the pupil or 
mydriasis. Conditions of the eye associated with increased intra- 
ocular tension are contraindications to mydriatics, as a rule. 

Myotics are drugs which cause contraction of the pupil or myosis. 
They are best represented by eserine. 

Nervous sedatives are indicated and contraindicated in a reverse 
manner to nervous stimulants. 

Nervous stimulants are contraindicated in nervous excitement, indi- 
cated in nervous depression. 

Oxytoxics are drugs which increase the expulsive power of the 
uterine muscular tissues. 

Revulsives are remedies used to produce increased activity of the 
general system or parts thereof through reflex influences — that is, 
they cause a determination of blood to one part, thereby relieving an 
engorged area. Thus, in cerebral congestion or effusion a vigorous 
purgative or cathartic may give relief by exercising a derivative 
effect. Revulsives are closely allied to counter-irritants. 

Roborants are drugs or measures devoted to the repair and build- 
ing up of tissues in the body, and comprise both foods and drugs. 
Roborant treatment also includes hygienic surroundings, fresh air, 
light and healthful employment. 

Tonics are used to increase vital activity. They are indicated in 
instances of local or general systemic depression, contraindicated in 
cases of inflammation or excitation with excessive functional activity. 
(See Bitters.) 

Vasomotor depressants are drugs which decrease arterial pressure 
by an action on the vasomotor nervous system rather than by an 
action on the heart. They act by relaxing the blood-vessels. 

Vasomotor stimulants are drugs which increase arterial pressure 
by an action on the vasomotor system, thereby producing contraction 
of the blood-vessels. 



INCOMPATIBILITY. 

The chief value of a knowledge of chemistry or pharmacy to a 
practitioner of medicine is the avoidance of what is known as an 
"incompatibility," or the placing in one prescription of two or more 
substances which will undergo chemical interchanges, decompositions, 
precipitations, or cause the formation of explosive mixtures. It is 
impossible to detail all the incompatibilities, and only the most dan- 
gerous and common possibilities of error can be considered : 

1st. An acid should never be combined with an alkali. 

2d. A strong acid should not be added in any quantity to a 
tincture. The following prescription is an illustration of this : 



42 GENERAL THERAPAUTICAL CONSIDERATIONS. 

R. — Potassii iodidi ^ij- 

Acidi nitro-muriatici {fy. 

Tr. cinchona? comp .'.... q. s. f^iij. — M. 

S. — Use as directed : a teaspoonful. 

In this ridiculous mixture the acid is incompatible with the iodide 
of potassium, forming a chloride and setting free iodine, and would 
also change part of the alcohol in the tincture into an ether. 

3d. Alkalies and neutral bases should not be combined with the 
alkaloidal salts. 

li . — Strychninae sulph gr. j. 

Potassii iodidi ^ij. 

Syr. sarsaparillae comp f§iij. — M. 

S. — Teaspoonful t. d. 

In this prescription the strychnine would be precipitated by the 
potassium salt, and the patient would get nearly all the strychnine in 
the last dose. 

4th. Potassium chlorate should not be ordered to be rubbed up 
with tannic acid nor any other organic substance capable of oxidation, 
as it will explode. Permanganate of potassium is subject to the same 
rule. 

5th. Chlorate of potassium and ammonium chloride when mixed 
together may take fire. 

6th. Iron is incompatible with tannic acid, as it forms a tannate of 
iron, or ink. As all the vegetable astringents contain tannic acid, they 
should none of them be used with iron except chiretta and columbo. 

7th. Tannic acid should never be added to solutions of alkaloids. 

8th. Gum arabic is not to be added to solutions of iron, lead, or 
the mineral acids. 

'.•rh. Alcoholic solutions of camphor and similar resinous substances 
are incompatible with water. 

10th. Fluid extracts are incompatible with water, as the addition 
of water will precipitate them. 

11th. All salts not acid but alkaline in reaction are decomposed 
by acids. 

12th. All salts which are acid are decomposed by alkalies. 

13th. All vegetable acid salts are altered by mineral acids and are 
decomposed by alkalies. 

14th. Iodine and the iodides should not be given with alkaloids. 

1 f>th. Corrosive sublimate, the salts of lead, iodide of potassium, 
and nitrate of silver should always be prescribed alone, except in the 
following instances : 

[a) Corrosive sublimate may be given with potassium iodide, 

Bince ii will throw down a precipitate which redissolves and forms 

a double salt. 

{!>) Nitrate of* silver may be used with extract of opium or hyos- 

c\ -sunns. 

KJth. Syrup of squill should not be given with the carbonate of 
ammonium, as it contains acetic acid. Chloride of ammonium is not 
incompat ible with it. 



CLASSIFICATION OF DRUGS. 



43 



17th. Cherry-laurel water should not be prescribed with morphine, 
as it may form the poisonous cyanide of morphine. 

18th. Chloral and cyanide of potassium should never be placed in 
the same prescription, as they will decompose each other, setting free 
hydrocyanic acid, 

19th. Cocaine and borax when added together form an insoluble 
borate of cocaine. Boric acid and cocaine do not result in this 
formation. 

20th. Calomel and antipyrin are incompatible, as are also sweet 
spirit of nitre and antipyrin. 

21st. Waters cannot be used in preparing saturated solutions of 
drugs, as they are already loaded with the volatile substance. 

22d. Pepsin and pancreatin should not be used together, since 
the former can only act in an acid and the latter in an alkaline 
medium, and the pancreatin is destroyed by the acid gastric digestive 
process. Further, one ferment may neutralize the other. 



CLASSIFICATION OP DRUGS. 

In order that the student may gain a definite idea as to the 
various actions of different remedies the following list of drugs is 
appended, which is of necessity somewhat arbitrary, and is not 
intended to be exhaustive, for many remedies might be placed in 
several classes. The endeavor has been made to place the best or most 
powerful drug of each class first in the list. It is to be remembered 
that a strict physiological classification is impossible. 



I. Alteratives. 

1. Mercury. 

2. The iodides of potassium and so- 

dium. 

3. Iodine. 

4. Iodoform. 

5. Iodol. 

6. Arsenic. 

7. Cod-liver oil. 

8. Colchicum. 

9. Ichthyol. 

10. Taraxacum. 

11. Mezereum. 

12. Nuclein. 

II. Anesthetics. 

1. Ether. 

2. Nitrous oxide gas. 

3. Chloroform. 

4. Cocaine. 

5. Eucaine. 

6. Bromide of ethyl. 

7. Chloride of ethyl and methyl. 

8. Pental. 

9. Bromoform. 

10. Carbolic acid. 

11. Antipyrin. 

12. Menthol. 



III. Antacids. 

1. Ammonia. 

2. Sodium and its salts. 

3. Liquor potassa. 

4. Magnesia. 

5. Lime. 



IV. Anthelmintics. 

Those that are used against the round- 
worm are — 

1. Santonica. 

2. Spigelia. 

3. Chenopodium. 

4. Azedarach. 

5. Santoninate of sodium. 



Those used against the tape-worm are- 

1. Pelletierine. 

2. Aspidium. 

3. Pepo. 

4. Pomegranate. 

5. Brayera. 

6. Kamala. 

7. Turpentine. 

8. Chloroform. 



44 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



Those used against the seat-worm, or 
oxvuris verrnicularis, are — 



Quassia. 
Turpentine. 
Tannic acid. 
Chloride of sodium. 
Vinegar. 



V. 



(See also Disinfect- 



Antiseptics. 
ants. ) 

1. Corrosive sublimate in weak so- 

lutions. 

2. Carbolic acid in weak solutions. 

3. Peroxide of hydrogen. 

4. Creolin. 

5. Lysol. 

6. Boric acid. 

7. Permanganate of potassium. 

8. Salicylic acid. 

9. Sulphate of iron. 

VI. Antipeuiodics or Antimalarials. 

1. Cinchona. 

2. Eucalyptus. 

3. Warburg's tincture. 

4. Arsenic. 

5. Methylene blue. 

VII. Antipyretics. 

1. Antipyrin. 

2. Acetanilid or antifebrin. 
Phenacetin. 
Guaiacol. 



3 

4. 

5. Phenocoll. 



6. 

7. 

8. 

'9. 

10. 



Quinine. 
Salicylic acid. 
Thallin. 
Carbolic acid. 
Kairin. 



VIII. Antispasmodics. 

1. Amyl nitrite. 

2. Chloral. 

3. Bromides. 

4. Opium. 

5. Belladonna. 

6. Camphor. 

7. Hoffmann's anodyne. 

8. Asafoetida. 

9. Musk. 

10. Valerian. 

11. Monobromated camphor. 
L2. Amber. 

L3. Cimicifaga. 

11. Hops. 

IX. AfiTRUrOl KPEB. 

Vegetable : 

1 . Tannic add. 

2. H;cmatoxylon. 
8. Kino. 

4. Oatechu. 

5. Rhatanv or kfameria. 
0. Rhus glabra. 

7. Geranium, 



8. White oak. 

9. Black oak. 

10. Gallic acid. 

11. Rosa centifolia. 

12. Rosa gallica. 

All of these depend chiefly upon tannic 

acid for their active principle. 
Mineral : 

1. Sulphuric acid. 

2. Alum. 

3. Lead. 

4. Nitrate of silver. 

5. Nitric acid. 

6. Sulphate of copper. 

7. Bismuth. 

8. Sulphate of zinc. 

X. Cardiac Sedatives. 

1. Aconite. 

2. Veratrum viride and albumen. 

3. Antimony. 

4. Hydrocyanic acid. 

5. Veratrum sabadilla. 

XL Cardiac Stimulants. 



1. 


Digitalis. 


2. 


Strophanthus. 


3. 


Ammonia. 


4. 


Ether. 


5. 


Alcohol. 


6. 


Caffeine. 


7. 


Nux vomica. 


8. 


Ignatia. 


9. 


Adonis vernaiis. 


10. 


Convallaria majalis. 


11. 


Sparteine. 


12. 


Amyl nitrite (momentarily) 


13. 


Opium. 



XII. Counter-irritants. 

Those counter-irritants that blister are 
called epispastics. They are — 

1. Cantharides. 

2. Thapsia. 

3. Ammonia or chloroform when 

under a watch-glass. 

Those that redden or produce local 

hyperemia of the skin are — 

1. Mustard. 

2. Capsicum. 

3. Turpentine. 

4. Ammonia. 

5. Chloroform. 

6. Burgundy pitch. 

7. Canada pitch. 

8. Most of the spices. 

Under the name of Escharottcs are 
grouped ;i number of substances 
capable of acting as destructive 
agents upon the soft tissues of the 
body. They are — 

1. Chromic acid. 

2. Nitric acid. 



CLASSIFICATION OF DRUGS. 



45 



3. Sulphuric acid. 

4. Nitrate of mercury (solution). 

5. Bromine. 

6. Caustic potash. 

7. Caustic soda. 

8. Burnt alum. 

9. Arsenous acid. 

10. Chloride of zinc. 

11. Vienna paste. 

12. Canquoin's paste. 

XIII. Diaphoretics. 

The only ones that we know as direct 
stimulants to the glands are — 

1. Pilocarpus or jaborandi. 

2. Warburg's tincture. 

The others are — 

3. Hot dry and hot moist baths. 

4. Dover's powder. 

5. Alcohol (particularly when hot). 

6. Nitrous ether. 

XIV. DlGESTANTS. 

1. Pancreatin. 

2. Pepsin. 

3. Hydrochloric acid. 

4. Diastase. 

5. Papain. 

XV. Disinfectants. 

1. Corrosive sublimate. 

2. Chlorine or chlorinated lime. 

3. Formaldehyde. 

4. Carbolic acid. 

5. Chloride of zinc. 

XVI. Diuretics. 

Those that increase both the solids and 
liquid constituents are probably — 

1. Caffeine. 

2. Squill. 

3. Cantharides. 

4. Buchu. 

5. Vegetable salts of potassium. 

6. Lithium. 

7. Juniper. 

8. Turpentine. 

9. Uva ursi. 

10. Chimaphila. 

11. Cubebs. 

12. Pareira brava. 

13. Blatta. 

Those which increase the watery con- 
stituents of the urine without in- 
creasing the solids proportionately 
are — 

1. Digitalis. 

2. Nitrous ether. 

XVII. Eliminatives. 
1. The iodides. 



2. The salicylates. 

3. The vegetable salts of potassium 

and the purgatives. 

4. The lithium salts. 

5. Jaborandi. 

6. Colchicum (probably). 

XVIII. Emmenagogues. 

The direct emmenagogues are — 



1. 

2. 
3. 
4. 


Apiol. 

Binoxide of manganese. 

Permanganate of potassium 

Cantharides. 


5. 


Aloes. 


6. 

7. 


Myrrh. 
Hue. 


8. 


Savine. 


9. 
10. 
11. 


Tansy. 

Pennyroyal. 

Guaiac. 


The indirect are — 


1. 


Iron. 


2. 


Arsenic. 


3. 
4. 


Copper. 

Tonics in general. 



XIX. Emetics. 

The direct are represented by — 

1. Apomorphine. 

2. Ipecac (which is both centric and 

peripheral). 

3. Tartar emetic (which is both 

centric and peripheral). 

The peripheral are — 

1. Sulphate of zinc. 

2. Mustard. 

3. Alum. 

4. Sulphate of copper. 

5. Turpeth mineral. 

XX. Expectorants. 
Sedative : 

1. Citrate or acetate of potassium. 

2. Ipecac. 

3. Antimony. 

4. Lobelia. 

Those which act as stimulating expec 
torants are — 

1. Ammonium chloride. 

2. Apomorphine. 

3. Creasote. 

4. Eucalyptus. 

5. Tar. 

6. Terebene. 

7. Terpine hydrate. 

8. Oil of sandal-wood. 

9. Sulphur. 

10. Grindelia robusta. 

11. Garlic. 

12. Squill. 



46 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



Besides these we have mix vomica, 
which increases expectoration by stimu- 
lating the nervous system to coughing, 
and thus expels the mucus. Opium and 
the bromides depress the nervous system 
and allay cough, and so decrease expecto- 
ration. 

XXI. Hypnotics. 

1. Chloral. 

2. Bromides of potassium, sodium, 

etc. 

3. Opium. 

4. Sulphonal. 

5. Trional. 

6. Tetronal. 

7. Paraldehyde. 

8. Chloralose. 

9. Chloralamide. 

10. Hypnal. 

11. Hyoscine (in mania). 

12. Duboisine (in mania). 

13. Cannabis indica (in large dose). 

XXII. Nervous Sedatives. 

1. Chloral. 

2. Opium (in full doses). 

3. The bromides and hydrobromic 

acid. 

4. Chloroform. 

5. Amyl nitrite. 

6. Nitrites of potassium and sodium, 

and nitroglycerin. 

7. Ether. 

8. Bromide of ethyl. 

9. Nitrous oxide. 

10. Bromoform. 

11. Belladonna. 

12. Antipyrin. 

13. Acetanilid. 

14. Phenacetin. 

15. Calabar bean. 

16. Hydrocyanic acid. 

17. Lobelia. 

18. Conium. 

19. Cannabis indica. 

20. Sulphonal. 

21. Croton chloral. 

22. Paraldehyde. 

23. Camphor. 

24. Monobromated camphor. 
25 Asafoetida. 

20. Amber. 

-7. I Io/1'mann's anodyne. 

28. dmicifoga. 

29. Musk. 

30. Valerian. 

81. Ilurniilus. 
32. GastOr. 

'■'>'■'>. Hvpn.tl. 

84. Tobacco. 

XXIII. N I ■; R vol- M I M I I . A NTS. 

1. Nux vomica. 

2. Ignatia. 



3. Coca. 

4. Kola. 

5. Caffeine. 

XXIV. Oxytocics. 

1. Ergot. 

2. Cotton-root. 

3. Ustilago maydis. 

And indirect when in labor : 

1. Quinine. 

2. Kola. 

XXV. Purgatives. 

Laxatives : 

1. Cascara sagrada. 

2. Sulphur. 

3. Ehubarb. 

4. Frangula. 

5. Cassia fistula. 

6. Euonymus. 

7. Magnesia. 

8. Manna. 

9. Fruits. 

Cathartics (mineral) : 

1. Magnesium sulphate. 

2. Magnesium citrate. 

3. Sodium phosphate. 

4. Potassium and sodium tartrate. 

5. Sodium sulphate. 

6. Mercury. 

Cathartics (vegetable) : 

1. Castor oil. 

2. Senna. 

3. Aloes. 

4. Podophyllin. 

Cathartics (hydragogue) : 

1. Elaterium. 

2. Jalap. 

3. Colocynth. 

4. Croton oil. 

5. Gamboge. 

6. Scammony. 

7. The saline purgatives, if con- 

centrated solutions are used. 

XXVI. Tonics. 

1. Cinchona. 

2. Nux vomica. 

3. Calumba. 

4. Arsenic. 

5. Phosphorus. 

6. Mercury (in minute doses). 

7. Copper. 

8. Iron. 

9. Hydrochloric acid. 

10. Nitro-hydrochloric acid. 

11. Nitric acid. 

12. Phosphoric acid. 

13. Condurango. 

14. The vegetable bitters in general. 



PRESCRIPTION WRITING. 



47 



XXVII- Vasomotor Depressants. 


XXVIII. Vasomotor St 


1. Amyl nitrite. 




1. Belladonna. 


2. Nitroglycerin and other nitrites. 


2. Hyoscyamus. 


3. Veratrum viride. 




3. Digitalis. 


4. Antimony. 




4. Nux vomica. 


5. Aconite. 




5. Ergot. 


6. Veratrum album. 




6. Stramonium. 


7. Veratrum sabadilla. 




7. Caffeine. 


8. Alcohol (in excessive 


doses). 


8. Convallaria. 


9. Jaborandi. 




9. Suprarenal gland. 



THE IMPORTANCE OP DIETETIC TREATMENT. 

Many physicians fail to pay proper attention to the regulation of the 
diet when treating those who are ill or " out of sorts." As a matter of 
fact, the administration of medicine often fails to produce good results 
simply because the patient, by persisting in the use of improper food and 
drink, is perpetuating the difficulty of which he is trying to get rid. 
There is scarcely a case in which some regulation or alteration of the 
diet will not be of advantage to the sick man. (See Foods for the Sick.) 
Further than this, failure to give directions as to diet is apt to give 
the patient the idea that the physician is careless, whereas care in this 
respect will greatly enhance his view of the doctor's ability to attend 
to important details of the case. 



PRESCRIPTION WRITING. 

When a physician directs a patient how to regulate his diet, what 
exercise he is to take, and how many hours a day are to be devoted 
to recreation and work, he prescribes for him quite as much as when 
he writes a prescription calling for one or more drugs which are to 
be dispensed by the druggist and swallowed by the individual who 
is ailing. Nevertheless, the word "prescription" is usually applied 
to the piece of paper on which is written the physician's order to the 
druggist. 

In writing prescriptions physicians usually employ Latin terms. 
There are several reasons for this. In the first place, it is a custom 
which has been followed since the time when medical science was in 
its infancy, and medical men were wont to write what they had to 
say in Latin. Secondly, the botanical names of plants are usually in 
Latin : first, because scientific men give them their names, and, 
second, because not infrequently the English name for a plant in one 
part of the country has an entirely different application in another. 
Thus, nearly every State has a drug called H Snake-root," yet in each 
instance a different plant may be so designated. Again, it is often 
advisable that a patient be kept in ignorance of the character of 
the drug which he is taking, lest he attempt to use it without a 
physician's advice on another occasion, and thereby do himself injury. 
Thus the physician might wish to give a patient a dose of coca as a 
powerful nervous stimulant, yet would fear that it might be taken 
without advice later on, and do harm. By using the word " Ery- 



48 GENERAL THERAPEUTICAL CONSIDERATIONS. 

throxylon " the druggist knows what to dispense, but the patient does 
not recognize the term used and fails to remember it. 

All prescriptions should be written on sheets of paper on which 
are printed the physician's name, address, and office hours. This 
information is obviously necessary, and particularly is it useful to the 
druggist, who may wish to communicate with the physician in case he 
thinks that a poisonous dose has been ordered by mistake. The name 
and address of the patient should be written on the prescription-blank, 
so that the druggist may know where the medicine is to be sent when 
it is prepared. The prescription is to be accurately dated. 

The first symbol or mark placed on a prescription-blank after 
writing the name of the patient and his address is "1$*," which stands 
for "Recipe," which is the second person singular of the imperative 
present of the Latin verb "Recipio," meaning " I take." Recipe or 
1^, therefore, says to the druggist " Take thou " of whatever sub- 
stances the physician desires. As he is to take a given quantity of 
his stock and place it in the mixture, the name of the drug is put in 
the partitive genitive case. When, however, a pill or other finished or 
complete product is ordered, so that not part of the stock, but the 
whole article is desired, the name of the medicine is placed in the 
accusative case, since it is the object of the verb. 

The nouns or names of drugs belong to one of the five Latin declen- 
sions, and are most of them declinable. Those of the first declension 
end in the letter "a" in the nominative singular, and in "ae " in the 
genitive singular, or "arum'' in the genitive plural, except in the 
case of the word aloe, the genitive singular of which is aloes. Thus 
aqua is the nominative, aquce is the genitive singular, and aquarum is 
the genitive plural. 

The nouns of the second declension end either in "us" if mascu- 
line," or "urn " if neuter. Their genitive singular ends in "i " and 
the genitive plural in "orum." There are several nouns of this de- 
clensioD which end in "on," like "luematoxylon," which also end in 
"i" in the genitive singular. Thus we find that Syrupus is the 
aominative, ISyrupi the genitive singular, and Syruporum the gen- 
itive plural. 

In the third declension the nouns end in a, e, i, o, y, c, 1, m, r, s, 
t. and x. The genitive singular ends in "is" and the genitive plural 
in ••inn.'' Thus. Mth&r in the genitive is JEtheris, and the genitive 
plural Mtherum, When the noun ends in "s" the genitive takes a 
u t" before the "is." Thus boras is the nominative singular, boratis 
the genitive singular, and horatum the genitive plural. 

In the fourth declensiou the masculine nouns end in "us," and the 
ueuter nouns in "u." The genitive singular of the masculine noun 
'•"•1-. a- does the pominative, in "us," and the neuter noun like the 
nominative ends in "u," while the genitive plural ends in "urn." 
Thus Spiritud, of which the nominative singular ends in "us," is 
%piritu% in lie- genitive singular, and spirituum in the genitive plural. 

In tin' fif'ih declension the nominative singular ends in " es," the 
genitive singular in "i," and the genitive plural in "rum." Thus 
Res has as its genitive singular rei, and as its genitive plural rerum. 



PRESCRIPTION WRITING. 49 

Adjectives used to qualify nouns agree with them in gender, num- 
ber, and case. 

After the ingredients and their quantities have been signified the 
physician expresses his wishes further, and writes the word "Misce," 
u mix " the ingredients. If the prescription is put up in fluid form, 
he next writes the signatura, and writes the word Signa, usually 
abbreviated by Sig., which tells the druggist to write the directions, 
which follow in English, on the label of the bottle. 

If the prescription consists in a powder and is to be put in papers, 
after the word Misce, or the letter U M.," which stands for misce, the 
physician adds et divide in chartulas No. xx. — that is, divide into 
twenty small papers or powders. If pills are desired, he writes 
M. fiant (often written "ft.") in pilulce No. xx. — that is, make into 
20 pills. 

Or fiat unguentum, let an ointment be made. 

Or the imperative may be used by the employment of the word 
fac, as fac suppositorias numero v. — that is, " Make thou 5 sup- 
positories." 

If capsules are desired, the druggist is directed to mix the ingredi- 
ents, and the physician adds et pone in capsulas No. xx. — that is, 
mix and put into 20 capsules. 

A prescription is often composed of a basis or the drug that is most 
important, an adjuvant or the drug to aid the basis, a corrective to over- 
come some effect which is undesirable, and a vehicle to give bulk and 
to carry the active substances into the body. After the name of the 
vehicle, which is also designed to bring up the mixture to a even 
quantity, we add the words quantum sufficit ad (a sufficient quantity 
to), usually abbreviated to " q. s. ad," to make the number of ounces 
desired. 

A complete prescription may therefore be written as follows : 

For Mr. John Jones, 

111 Blank Street, 

October 31, 1901. 

1^. — Bismuthi subnitratis gr. xl. 

Creosoti Ttlx. 

Misce et pone in capsulas No. xx. 
Signa. — Take one after each meal. 
Or 

1^. — Acidi sulphurici aromatici f^ij* 

Extracti hsematoxyli fluidi f3iv. 

Spiritus chloroformi f^j. 

Syrupi zingiberis . . . . . q. s. ad f^iij. 
Misce. 
Signa. — Take 1 dessertspoonful in water every three hours. 

In the last prescription the sulphuric acid is the basis, the hsema- 
toxylon and spirit of chloroform are the adjuvants, and the syrup of 
ginger is the vehicle. 



PART II. 
DRUGS. 

ACACIA. 

Acacia, U. S., Acacia? Gummi, B. P., Gum Arabic or Gum Acacia, 
is a gummy exudate from the stems and branches of small trees known 
as Acacia Senegal, and other acacias growing in Northern Africa and 
in Australia. As sold in the stores it consists of irregular semi- 
transparent lumps, which are either smooth or angular, according to 
whether the substance has been preserved in the original beads or 
broken by handling. Its color is slightly yellow or almost white, 
both color and transparency depending largely on the amount of the 
impurities by which it is contaminated. 

It is devoid of physiological action. 

Therapeutics. — Acacia is employed in medicine as a local applica- 
tion to inflamed and irritated mucous membranes, particularly of the 
upper air-passages, and also when dissolved in water in the form of a 
drink when the same conditions exist in the mucous membranes of the 
alimentary canal and genito-urinary tract. In all these states it is useful 
as a vehicle for more powerful remedies. Made into a mucilage with 
flaxseed, to which liquorice may be added, it is largely employed to 
loosen a hacking cough in children or in adults. The flaxseed should 
not be boiled, but allowed to stand on a moderately warm part of the 
"range," and the gum-arabic solution added with a little lemon-juice 
for flavoring purposes. Acacia is chiefly used in pharmacy for making 
pills, emulsions, and similar preparations, and is official in the form 
of the mucilage of acacia (Mucilago Acacia?, U. S. and B. P.) and 
the syrup of acacia (Syrupus Acacias, U. S.), the first containing 340 
grms. of acacia and water enough to make 1000 grms., and the sec- 
ond 25 c.c. of the mucilage to 75 c.c. of syrup. 



ACETANILID, or ANTIPEBRIN. 

Acetanilidum, U. S. and B. P., was first employed in medicine by 
Cahn and Hepp, and is a white crystalline material only slightly sol- 
uble in water, but completely soluble in alcohol and ether. Applied 
to the tongue, it causes a burning sensation which is very slight. It 
has been known to chemists for many years, and is made by the action 
of glacial acetic acid upon aniline, forming acetaniiid or phenyl-aceta- 
mide. The word antifebrin is a registered name, and should be avoided 

51 



52 DRUGS. 

by the profession, since its employment obliges the druggist to use the 
acetanilid made by one firm instead of the compound made by other 
chemists, who are able to make the drug as an ordinary chemical com- 
pound, and do not charge so high a price as do those holding control 
over the registered name. 

Physiological Action. — Acetanilid has been studied experimentally 
and clinically to a very great extent, and fairly definite outlines of 
its action have been mapped out. 

Nervous System. — On the nervous system acetanilid has been 
found to act as a sedative, the sensory portion of the nerves and spinal 
cord particularly being quieted. After a poisonous dose general anaes- 
thesia comes on, with total loss of reflex action and with motor and 
sensory paralysis. The portions of the nervous system involved in 
these changes are, primarily, the sensory side of the spinal cord and 
the sensory nerves, the motor apparatus being least affected. The 
muscles are not influenced by the poison, except indirectly. 

Circulation. — On the circulation acetanilid has but little direct 
influence except when used in poisonous doses. Applied to the frog's 
heart, it at first accelerates its beat and increases its force, but soon 
causes a weakening, ending with arrest in wide diastole. Upon the 
higher animals it causes, in toxic dose, an immediate fall of arterial 
pressure with a diminution in the size of the pulse-waves and all the 
evidences of cardiac and circulatory depression, notwithstanding the 
fact that death ensues from respiratory failure. The cause of this 
fall of blood-pressure is a direct depressing action on the heart asso- 
ciated with failure of the vasomotor system, as asphyxia causes no 
rise in pressure. 

In medicinal dose acetanilid causes no circulatory changes of any 
moment in the healthy individual. Sometimes the pulse-rate is in- 
creased, sometimes diminished. The tendency is, however, toward 
depression rather than stimulation of the circulation. 

BLOOD. — The action of this drug upon the blood, when used in 
large doses, is more pronounced than its influence upon any other 
part of the body, causing this tissue to become brownish-red, de- 
creasing its oxygen-carrying power, and, finally, reducing the hsemo- 
globin to methnemoglobin to a very considerable extent. The ques- 
tion as to the influence of acetanilid upon the corpuscles is still 
somewhal undecided, some observers declaring that these bodies are 
disorganized, while others assert that they remain intact. In mod- 
erately hiiL r <' poisonous doses it may not affect the corpuscles, but if 
its use in large amount ho maintained for some days, or a very large 
amount be used at one time, corpuscular destruction certainly occurs, 
free haemoglobin appearing in the urine in its characteristic forms. 
The Dormal alkalinity of the blood is decreased, and the urine becomes 
dark and brownish in color, so that the blood-crystals of Teichmann 
may ho found in it. In medicinal doses the blood shows no change 
except in '-use- where idiosyncrasy is presentorthe doses are unusually 
I nder these circumstances the blood in the arterial system 
becomes more blue than normal. 

ReSPIBATION. — No effect is produced upon this function by acctan- 



ACETANILID, OR ANTIFEBRIN. 53 

ilid when given in moderate doses. When poisonous doses are used 
the breathing at once becomes rapid and then impaired and labored. 
Large doses produce death by paralysis of the respiratory centres. 
The causes of these changes are, primarily, the alterations in the 
blood, which so influence oxygenation of the tissues as to lead the 
respiratory centre to greater effort, while at the same time it is begin- 
ning to be directly depressed by the drug itself, so that impairment of 
its function is soon manifest. Bokai asserts that the drug paralyzes 
the peripheral motor nerves, which, if true, brings forward a third 
factor in the respiratory failure. 

Temperature. — When given in full medicinal doses, acetanilid 
lowers the normal bodily temperature or else fails to produce any 
change. In poisonous doses it produces a decrease in temperature 
depending on the amount employed, and may cause collapse and 
rigors. On a fevered temperature it acts as a powerful and fairly 
constant antipyretic, lowering the fever by decreasing heat-production 
and increasing heat-dissipation, heat-production being the function 
most affected. 1 Whether the decrease in heat-production is due to an 
iction on the heat-centres in the nervous system, or upon other causes, 
Is not positively known. Some investigators have claimed that the 
fall depends upon the partial reduction of the haemoglobin of the 
blood, whereby less oxygen is carried to the tissues and less combus- 
tion ensues. This seems doubtful, in view of the fact that the most 
Careful spectroscopic examination of the blood fails to show any such 
change from the use of medicinal doses. That the fall of tempera- 
ture is not dependent on the sweat produced is proved by the fact that 
the temperature falls even if enough atropine be given to stop all 
perspiration. 

Kidneys, Tissue-waste, and Urine. — Much contradictory evi- 
dence exists in regard to the changes which occur in these organs and 
their excretory products under the influence of acetanilid, but most 
observers agree that the excretion of urea is increased, and it is a 
fact that the more laborious researches which have been undertaken 
have reached a similar result (Lepine, Chittenden, and Taylor). Less 
uncertainty exists as to its influence on the elimination of uric acid, 
which is increased rather than diminished by the drug. After exces- 
sively large doses the urine becomes dark from the presence of broken- 
down blood-coloring matter. 

Elimination. — The drug is eliminated by the kidneys as para- 
amido-phenol sulphate, and is entirely passed out of the body in about 
twenty-four hours. 

Antiseptic Action. — The drug possesses distinct antiseptic powers, 
but is not capable of acting as a disinfectant. (See Therapeutics.) 

Toxic Changes from Prolonged Use. — Although it has been claimed 
that no untoward effects result from the prolonged use of acetanilid 
in large doses, there can be no doubt that this is untrue. Under these 
circumstances congestion of the liver, kidneys, and spleen occurs, and 
if the dose be poisonous, clots may be found in the cardiac cavities. 

1 My reasons for holding to the opinions stated can be found in my Boylston Prize 
Essay of Harvard University, on Antipyretics. 



54 DRUGS. 

There may be also a progressive decrease in the number of the red 
blood-corpuscles. 

Poisoning. — In man this drug in toxic quantity causes the lips to 
become blue, the face livid, cyanosed, expressionless, or anxious. 
The forehead and cheeks become covered by beads of sweat, which 
gradually extend over the rest of the body. The pulse is soft and 
compressible, but slow, and finally very weak. The respirations become 
slow and shallow. 

The treatment of a case of poisoning by acetanilid should consist 
in supporting measures, the use of stimulants, external heat, bella- 
donna to maintain blood-pressure, strychnine to aid the respiration, 
and oxygen inhalations if they are necessary to combat cyanosis. 

Therapeutics. — The employment of acetanilid in fevers must depend 
very much upon the condition of the patient and the form of his dis- 
ease. The mere existence of a high temperature cannot, correctly 
speaking, be an indication for any particular remedy. The phase of 
the disease must be recognized, and the question as to whether the 
fever which is present is harmful must be duly weighed. (See Treat- 
ment of Fever, Part IV.) 

In typhoid fever, though the drug possesses very decided anti- 
pyretic power, it often causes great depression and collapse, and in 
no way influences for good the duration or general course of the 
disease. 

For the same reasons the use of acetanilid in phthisis is inad- 
visable, for, although it greatly affects the hectic fever, it is very apt to 
cause collapse, profuse sweating, and depression. Thus the writer has 
repeatedly seen cases of phthisis in which the attempt to control the 
fever by this drug resulted in the symptoms just named ; and Riese 
points out, what the author has also noted, namely, that in this dis- 
ease cyanosis is very apt to come on after the use of the drug. 

In regard to the employment of acetanilid in sthenic fevers, it at 
once becomes evident that a drug absolutely unsuited to a case of 
asthenic disease may, on the other hand, agree with a sthenic-fever 
patient very well. In consequence of this, we find that the sweating 
produced by acetanilid is not so marked or troublesome in diseases of a 
dynamic type, and that, in consequence, it more rarely causes collapse ; 
but even in this class of cases, and particularly in both varieties of 
pneumonia, the use of acetanilid is rarely advisable. Indeed the anti- 
pyretic use of this and similar compounds is yearly becoming less 
and less. 

In much the same manner that antipyrin was found, some time 
after it< introduction, to be possessed of pain-relieving power, so ace- 
tanilid has been discovered to possess similar properties — a discovery 
the credit of which must be given to the French investigator Lepine. 
Almost every form of nerve-pain seems to indicate its employment. 
It has been Buccessfuly used in the crises of ataxia, the agonizing 
dartings of gaitralgia^ in cases of sciatica, and severe headaches often 
yield i" its influence. A large amount of experience has proved it to 
lie of value in epilepsy. 

The employment of acetanilid in acute rheumatism may be separated. 



ACETANILID, OR ANTIFEBBIK 55 

if desired, into that devoted to the cure of the disease, with the relief 
of pain, and the reduction of pyrexia. There can be no doubt what- 
ever of the ability of the drug to control the fever of this disease, 
and the question as to whether it favorably influences the severity of 
the pain of the malady is to be answered very forcibly in the affirma- 
tive. (See Rheumatism, Part IV.) The dose for cases of rheumatism 
should be 4 (0.2) to 6 grains (0.5) three times a day. In subacute 
rheumatism of the muscular type acetanilid will often give great relief. 

Acetanilid is of great value in the treatment of chancroids when 
used in dry powder, and in the antiseptic dressing of wounds when 
used alone or with equal parts of borax. 

In many cases of obstinate vomiting, particularly that following 
surgical operations when an anaesthetic has been used, acetanilid is a 
useful remedy. The drug is usually best given in the dose of 1 grain 
(0.06) every half hour until 6 grains (0.5) are taken ; and the follow- 
ing prescription may be used in compressed tablet, pill, or powder, 
preferably the latter, in order to increase the sedative effect on the 
stomach and steady the heart : 

R. — Acetanilidi gr. vj (0.4). 

Caffein. citrat gr. iij (0.2). 

Camphor, monobromati gr. vj (0.4). — M. 

Ft. in pil. vel chart. No. vi. 
S. — 'Wash down with a little water or else dissolve powder in a drachm of 
brandy ; pour over cracked ice, and give it from a spoon. 

Acetanilid has even been recommended when applied locally as a 
haemostatic in epistaxis, and has been given internally with asserted 
advantage in hcemoptysis. 

Acetanilid very distinctly increases the susceptibility of a patient 
to cold, and for this reason it should not be used for the relief of neur- 
algic or other pain before leaving the house in cold weather if it can 
be avoided. 

Untoward effects are not very common if acetanilid be used with 
care. The writer has collected a number of cases (thirty-eight) in which 
unfavorable signs appeared after its use, but untoward action was never 
seen unless the dose given was excessive for the case which received it. 
The dose most commonly producing such symptoms was from 3 (0.15) 
to 10 grains (0.65). In only three instances of the series did death 
occur — one from heart-clot and two from excessive dosage. No deaths 
were reported from moderate amounts, although some of the cases were 
very alarming. Very rarely symptoms of poisoning by acetanilid, such 
as are described on p. 54, follow its now general use as a dusting powder 
over wounds and other breaks in the skin. 

Administration. — Acetanilid may be given in doses varying from 
2 (0.1) to 10 grains (0.65), the last-named amount being usually far 
too much. As it is virtually insoluble in water, it should always be 
administered in wine or spirit, in which it will dissolve, or in capsules 
or pills. The antipyretic effect begins to be felt about one hour after 
the drug is taken. When neuralgias are to be treated or similar 
forms of pain are present, monobromated camphor, in the dose of J 
a grain (0.032), may be combined with acetanilid with advantage. 

The prescription given above may be used, or the following : 



56 DEUG'S. 

R.— Acetanilidi gr. xx (1.3). 

Camphor, monobromati gr. v (0.3.) — M. 

Ft. in pil. No. x. 
S. — One every two hours. 

This pill is not to be used if there is reason to believe that marked 
renal congestion or irritation is present. 

ACETATE OP POTASSIUM. 

Potassii Acetas, U. S. and B. P., is a neutral white salt of saline 
taste, readily deliquescent and soluble in water. It was at one time 
very largely used in the treatment of acute rheumatism in the ''alka- 
line method/' as when it enters the blood it is changed into an alkaline 
carbonate. It has, however, been supplanted by the salicylates in the 
treatment of most cases of rheumatism. The dose should be from J 
to 1 ounce (15.0-30.0) a day. A combination of 10 grains (0.65) of 
the iodide of potassium and 30 grains (2.0) of the acetate is useful in 
subacute rheumatism in some instances. 

In hepatic torpor acetate of potassium is exceedingly useful, and 
aids in promoting the flow of bile as well as that of the urine. It has 
been used in the treatment of the so-called uric-acid diathesis, and acts 
powerfully in rendering an acid urine alkaline. At one time it was 
supposed to purify the blood by aiding in the oxidation of effete 
material. The dose of potassii acetas is from 20 grains to 2 ounces 
(1.3-62.0), but the latter dose is employed only when a purgative 
effect is desired, and other drugs are more suitable for this purpose. 

ACETIC ACID. 

Acidum Aceticum, U. S. and B. P., as used in medicine, is a 
clear liquid made up of 36 per cent, of glacial acetic acid and 64 per 
cent, of water, and has a sweetish odor. It is obtained from wood by 
destructive distillation. 

Acetum, or Vinegar, is practically a dilute acetic acid. 

Therapeutics. — Acetic acid is seldom used internally. As a pow- 
erful escharotic the glacial or absolute acetic acid [Acidum Aceticum 
Glaciale, U. S. and B. P.) is used. It can be applied to warts and 
other growths, and to old sores where the granulations are profuse and 
slow to heal. The dilute acid {Acidum Aceticum Bilutum, U. S. 
and H. P.) is used as a lotion in night-siveats and to arrest epistaxis 
and other small haemorrhages. As a lotion to be widely employed 
it should be diluted one-half. Vinegar, or dilute acetic acid, has been 
used internally for the decrease of obesity, but is a harmful and useless 
remedy, disordering digestion and reducing the patient's strength. 

Sometimes inhalation of vinegar funics from a cloth saturated with 
this liquid will control vomiting after the use of an anaesthetic. 

In the following mixture; acetic acid has been used with success 
for the removal of vegetations about the external genitals: 

li. — Acid. s:ilic\ lie gr. XXX (2.0). 

Acid, acetic fgj (30.0).— M. 

S. — Apply with ;i camel' s-hair brush. 

Very little pain Is caused by this application. 



ACOINE— ACONITE, OB MONKSHOOD. 57 

Poisoning. — When over-doses of acetic acid are taken the treat- 
ment consists in the use of large doses of milk, alkaline liquids, such 
as lime-water, soap-water, etc., and the general measures adopted for 
the treatment of gastro-enteritis. (See Gastro-enteritis, Part IV.) 

Contraindications. — Nursing mothers should not take freely of 
vinegar, as it may produce a troublesome diarrhoea in the nursling. 



ACOINE. 

Acoine is a synthetic substance introduced into ophthalmic surgery 
as a local anaesthetic and antiseptic. It is used in a 1 or 2 per cent, 
solution. 



ACONITE, or MONKSHOOD. 

The aconite of the U. S. P. and B. P. is derived entirely from the 
tuberous root of Aconitum Napellus. At one time the leaves were 
official, but are so no longer, and for this reason the term " radix '' is 
not to be employed, as it is a useless distinction. 

Aconite is indigenous in Germany, France, and Switzerland, and 
is cultivated as a garden-plant all over Europe and America. The 
root is so strikingly like that of horseradish as to be readily confused 
with that article of food, but does not emit the pungent fumes of the 
latter when it is scraped or broken. It is to be remembered, how- 
ever, that it produces a distinct feeling of heat in the mouth when 
chewed. The active principle upon which the therapeutical value of 
aconite would appear to depend is aconitine, but there is reasonable 
doubt whether this can be relied upon as completely as the preparations 
of the crude drug : the aconitine of commerce, moreover, varies very 
much in strength, because some of it is amorphous and impure, while 
other samples are very pure and crystalline. Further than this, even 
the crystalline form is exceedingly variable. In addition to aconitine, 
Dunstan asserts that there are two amorphous alkaloids — namely, benz- 
aconine and aconine. Aconitine is 200 times as toxic as benzaconine 
and 2000 times as toxic as aconine. 

Physiological Action. — When aconite is placed on the tongue it 
produces a sensation of tingling and burning which extends' over the 
pharyngeal surface and into the stomach if the drug is swallowed. 
This is due to its primary irritant and secondary benumbing action on 
the sensory nerve-endings of the mucous membrane. It sometimes 
causes a sensation of constriction in the fauces. 

Nervous System. — In full medicinal dose aconite depresses the 
functional activity of the perceptive centres in the brain, the sensory 
side of the spinal cord, but chiefly depresses the peripheral ends of the 
sensory nerves. Applied to a mucous membrane, it acts as a local an- 
aesthetic, but is too irritating for this use in the eye. On the motor 
portion of the body it exerts little influence unless given in large, 
poisonous doses, when it paralyzes the motor tract of the spinal cord 
and the peripheral motor nerves. 



58 



DRUGS. 



Fig. 5. 




Circulatory System. — When aconite is given in moderate medic- 
inal dose it exercises no marked effect on any part of the organism 
save the circulation, which becomes somewhat slower by stimulation of 
the vagus centres and by the drug acting as a sedative to the heart- 
muscle itself. The arterial pressure is slightly decreased by these doses, 

chiefly by the decrease in cardiac force. 
If large doses are used, the pulse be- 
comes still more feeble and slow, and 
the arterial pressure falls from depres- 
sion of the vaso-motor centre. When 
a poisonous dose is given it causes 
first a very marked fall in pulse-rate 
and arterial pressure, preceded some- 
times by a quickening due to a con- 
dition of weakness and abortive cardiac 
action : this condition gradually passes 
into diastolic arrest of the heart, the 
viscus becoming paralyzed and refusing 
to respond to stimuli. 

Respiration. — In moderate doses 
aconite quiets the respiratory move- 
ments slightly, particularly if the 
breathing is hurried. In poisonous 
doses it paralyzes the respiratory 
centres, and so causes death. 

Temperature. — Aconite acts as a 
distinct reducer of fever, probably be- 
cause of increased heat-radiation arising from relaxation of the capil- 
laries and impaired circulation. 

Absorption and Elimination. — Aconite is rapidly absorbed 
and destroyed by oxidation, so that its effects do not last for any 
length of time. The effect of aconite when given in a large medicinal 
dose lasts for about three hours. It usually increases the urinary flow. 
Poisoning. — When aconite is taken internally in excessive amount 
it causes tingling of the mucous membranes wherever it touches them, 
which sensation finally amounts to severe burning. This soon passes 
away, and is followed by a sense of tingling about the lips and finger- 
tip- or all over the skin. At the same time the patient feels relaxed; 
the pulse at first becomes weak and slow, but later on may be rapid and 

running, so that it seems a mere trickle under the finder; sweating more 

ill 
or Less marked is present, and fainting may ensue. Vomiting may occur, 

Ion is rare. Tin- respirations now become slow and shallow, seeming to 

expand the lung to the smallest possible extent consistent with life. 

'he face is pallid and anxious. Consciousness is preserved unless lost 

There may be exophthalmus, or the 

The sclerotic coat of the eye is pale 

excessive pallor. Clonic convulsions 

occur. There may be marked ames- 

mpils may be norma], contracted, or di- 



A, Vasrus centre stimulated by aconite, 
which slows pulse ; B, heart-muscle 
depressed, which slows pulse; c, 
vaso-motor centre depressed, which 
lowers arterial tension ; d, respira- 
tory centre depressed. 



through an attack of >vm-ope. 

may be sunken ami dull. 
and pearly-looking. There is 
of unknown origin sometimes 

thesia of the skin. The 



lated to a \\i<l< 



degree. 



Tl 



ie 



temperature of the bodv is very low. 



ACONITE, OR MONKSHOOD. 59 

Death may be gradual or sudden, the slightest movement of" the 
body which can throw any strain on the heart stopping that organ 
in diastole. 

Treatment of Poisoning. — The patient is to be placed in a prone 
position on a bed or board, with the feet higher than the head, in order 
to confine the circulation as far as possible to the vital centres at the 
base of the brain. Hot bottles or bricks are to be placed about the 
body for the purpose of maintaining the bodily heat. Emetics are not 
to be given if the symptoms are severe, as vomiting may cause cardiac 
failure, owing to the muscular effort involved, or the stomach may be 
so depressed that the emetics will not act. If vomiting comes on, it 
should be into a towel, the patient not being allowed to raise his head. 
The stomach is to be washed out by means of a stomach-pump or a 
siphon made of rubber tubing. Ether may be given hypodermically, 
and followed by alcohol, and this again by digitalis. The ether acts at 
once, and lasts while the alcohol is being absorbed, and the alcohol sup- 
ports the heart until the digitalis, which is the physiological antagonist 
of aconite, but slow and prolonged in its effects, asserts itself. Atropine, 
because of its stimulating effect on the vaso-motor system, may also be 
used. If the breathing fails, artificial respiration is to be employed, or 
if the heart seems about to cease its action, a whiff of the nitrite of 
amyl may start it going again, but only a few drops of the nitrite should 
be used, as large amounts depress this organ. Full hypodermic doses 
of strychnine, such as -^ to -^ (0.003-0.006) of a grain, may be given 
to stimulate the respiration and heart. 

Untoward Effects. — Aconite may cause in susceptible persons a 
vesicular, or even a pustular, eruption, or instead intense itching of the 
skin may be developed. 

Therapeutics. — The employment of aconite in disease is one of the 
most universally recognized procedures in medicine. It fulfils indi- 
cations which nothing else can, and lends itself to the control of a 
large number of morbid processes, its effects being uniformly explain- 
able by its known physiological action. It is used chiefly for its 
influence as a cardiac and circulatory sedative, for its effects on the 
peripheral sensory nervous system, as in the vomiting of pregnancy, 
and in those states in which, through inflammation elsewhere, the 
nervous system needs a sedative which will simultaneously reduce 
arterial tension. In the early stages of all acute inflammations aco- 
nite is of service. It may be applied locally over superficial nerves 



in neuralgia in the form of an ointment (2 grains [0.1] to 1 drachm 
)], or as the oleate of aconitine, 2 grains [0.1] of the oleate to 
100 [6.0] of sweet oil). In the earlier stages of gonorrhoea aconite 



in small doses frequently repeated is a most valuable remedy, and 
later in the disease tends to prevent chordee by its influence on the 
nervous centres. It is useful in croup, quinsy, sore throat, severe 
colds, bronchitis, and asthma due to exposure, in their early stages. 
When suppression of menstruation follows an exposure to cold, this 
drug, given with a hot drink and a hot sitz bath, will often restore the 
normal flow. In pericarditis it is valuable to allay the inflammation 
and quiet the excited heart, and it is also of great value in the earliest 



60 DRUGS. 

stages of sthenic pneumonia if great arterial excitement is present. 
Aconite is by far the best circulatory and nervous sedative for children 
suffering from sthenic fevers, particularly of the irritative type. It 
ought not to be used in adynamic, asthenic affections. Aconite is use- 
less and harmful in prolonged acute diseases, such as scarlet fever, if 
constantly employed. 

In persons who suffer from asthma which is preceded by coryza 
aconite does good if given in the earliest stages. 

In nervous palpitation of the heart and in the palpitation of exces- 
sive cardiac hypertrophy aconite is very valuable. In many cases of 
this character where there is not only hypertrophy, but irregular inner- 
vation, the use of a prescription containing aconite and digitalis proves 
of service, for the minute doses of digitalis stimulate the vagus nerves, 
and the aconite not only steadies the heart by its stimulant effect on 
the vagus, but also counteracts the stimulant effect of the digitalis on 
the heart muscle : 

R.— Tine, aconit f^ss (2.0). 

Tine, digital f^ss (2.0). 

Tine, belladonnae f ^j (4.0). 

Tine, gentian, comp q. s. ad f^iij (90.0). — M. 

8. — Tcaspoonful every six hours. 

In the epistaxis of full-blooded people aconite often affords great 
relief. 

Full doses of Duquesnel's crystalline aconitine are of value in some 
cases of obstinate neuralgia. This crystalline salt is about 4 times 
stronger than the amorphous variety. 

Administration. — As a general rule, small divided doses of the 
drug in the form of the tincture, \ to \ a minim (0.015-0.030) given 
every fifteen minutes, will act better than a full dose given at once, 
unless the condition of the patient requires very active treatment. 

Preparations. — Tincture of aconite (Tinctura Aconiti, U. S. and 
B. P.) is used in the dose of 1 to 5 minims (0.06-0.30) in water, re- 
peated every hour if needed so often. A very useful way of employ- 
in e it is in the form of tablet triturates. The extract of aconite 
| mxtractwm Aconiti, U. S.) is given in the dose of \ to f of a grain 
(0.015-0.045), while of the abstract (which is no longer official) 1 
grain (0.06) is used. The fluid extract (Extractum Aconiti Fluidum, 
('■ S.) is giveu in the dose of 1 to 2 minims (0.05-0.1). Fleming's 
tincture ought never to be used. The active principle aconitine (Aconi- 
tma t li. P7\ is not official in the U. S. P. Its dose is ^ to yj^ of a 
-nun (0.0003-0.0006), but it ought never to be used internally. The 
/>'. P. preparations that are not official in the U. S. P. are: aconitine 
(Aconitma), aconite ointment (Unguentum Aconitinw), and aconite 
liniment (Linimentum Aconite). 

ADONIS VERNALIS. 

From Adonis vernalis, a plant indigenous in Europe and Asia, is 
derived a glucoside, Adonidiii. When given to one of the mammalia 
— the dog. lor instance — it causes an increase in heart-force and a 



AGARICIN— ALCOHOL. 61 

rise of arterial pressure. In the frog poisonous amounts arrest the 
heart in diastole. 

The indications for the use of adonis are all conditions of cardiac 
failure, particularly the presence of cardiac dropsy. It is much infe- 
rior to digitalis and caffeine, but may be employed when these fail, as 
it sometimes succeeds under such circumstances. Within the last few 
years adonis vernalis and bromides have been combined in the treat- 
ment of epilepsy with asserted success. 

The dose of adonidin is \ to J of a grain (0.008-0.016) three times 
a day ; or 4 to 8 parts of the plant — all portions of which are employed 
— may be added to 180 parts of water, and of this infusion a half 
ounce (15.0) may be given every four hours. 

AGARICIN. 

Agaric, or Touchwood, or Punk, has been used in the Southern 
United States very largely in the dose of 5 grains (0.3) every few 
hours in the treatment of the night-sweats of phthisis ; and agaricin, 
the alcoholic extract of the drug, has been used with very extraordi- 
nary results, under these circumstances, by certain German and 
English physicians, in the dose of from 1 'to 2 grains (0.06-0.13) 
every five hours. Its physiological action is unknown, but it is sup- 
posed to act upon the nerve-filaments in the sweat-glands. The 
writer has employed it frequently in varying dose, and has never 
seen any decrease whatever produced by it in the sweats of phthisis, 
although he has watched it most closely, expecting to see great relief 
follow its use. Sometimes agaricin causes nausea and diarrhoea. 

ALCOHOL. 

Ethyl Alcohol {Alcohol Ethylicum) is the only alcohol used in 
medicine. Some of the other alcohols are exceedingly poisonous. 
Amylic alcohol is fusel oil. 

Alcohol is a liquid derived from the fermentation of starches or 
sugars in the presence of heat. It is official in four forms — namely, as 
Alcohol, U. S., containing 91 per cent, by weight of the spirit and 9 per 
cent, of water ; Alcohol Absolutum, U. S. and B. P., containing not more 
than 1 per cent, by weight of water; Alcohol Deodoratum, containing 
92.5 per cent, by weight of alcohol; and Alcohol Dilutum, U. &., 
or dilute alcohol, 41 per cent, by weight of spirit and the remainder 
water. The drug is generally given in the form of whiskey or brandy, 
and when the word alcohol is used in the saying, " Give the patient 
alcohol," one of these two liquids is always meant unless it is other- 
wise stated. 

Notwithstanding the almost universal use of alcohol as a stimulant 
by the laity and the medical profession, it cannot be denied that evi- 
dence of scientific character and weight is constantly being brought 
forward that its dominant action is depressant upon all parts of the 
body. It is claimed that under its influence the total amount of work 
accomplished in a given space of time is less than when it is not taken, 



62 



DRUGS. 



and that the quickening of the pulse under its influence is more 
apparent than real. On the one hand, therefore, a vast mass of evi- 
dence seems to exist against the general employment of alcohol as a 
stimulant ; while on the other clinical experience, too great to be 
ignored, stands for the continued employment of the drug. While the 
author is forced to admit that the pharmacological evidence is strong, 
he still deliberately allows the text which follows to remain as in 
earlier editions, still employs alcohol as a stimulant as before, and fully 
believes that its administration is often followed by most beneficent 
results which other drugs will not produce. 

Physiological Action. — Nervous System. — Alcohol acts first as a 
powerful excitant, and afterward, when given in very full dose, as a 
most active depressant and paralyzant of the nervous system. Locally 
applied in small amounts to the peripheral nerves, it excites them at 
first and paralyzes them afterward. By the primary stimulation of 
the brain it increases the rapidity, but not the depth, of thought, and 
it increases the reflex activity of the spinal cord, the muscles, and 
the nerves. In large doses it produces lack of co-ordination by 
depression of the brain and lower nervous system, the loss of co-ordi- 
nation being due largely to impairment of sensation, so that the power 
of touch and the muscle sense is interfered with. This makes a 
drunken man fail to recognize the angles or uneven surfaces of sur- 
rounding objects, and the impaired mental power and disordered judg- 
ment, combined with the badly-acting motor and sensory pathways, 
cause him to stumble and fall. 

Circulatory System. — When alcohol is ingested, either by man 
or the lower animals, it stimulates the heart-muscle and increases the 
rapidity as well as the force of its beat. According to Dogiel, the 
increase in rate is partly due to stimulation of the accelorator nerves, 

but Castillo denies any such influence. 
Wood teaches that the effect of alcohol 
is not through any action upon these 
nerves, but upon the heart itself, and 
is probably correct in his belief. 
Along with the stimulation of the 
heart a rise of arterial pressure en- 
sues, largely due to increased heart 
action and partly to vasomotor stimu- 
lation. In very large toxic doses 
alcohol depresses and finally paralyzes 
the heart and vasomotor system as 
well as the nervous system. 

Respiration. — Respiration is 
stimulated by small doses of alcohol 
and decreased by large ones. 

Temperature. — Alcohol at no time 
increases to any extent the actual num- 
ber of heat-units in the body. It pro- 
duces a sensation of warmth, and warms 
the extremities by causing the heart to pump hot blood from the 



Fig. 6. 




d t Alcohol itimulatef the heart muscle; 
/;. and the vasomotor centre In the 
medulla, 



ALCOHOL. 63 

centre of the body to the cold parts. If it be used in excess, the 
temperature rapidly falls, owing primarily to the increase of heat-radia- 
tion produced by the excessive distribution of heat just named, and 
secondarily by the depression of vital power which is caused by a too 
rapid destruction of the tissues of the body in the effort induced by 
the drug. Calorimetrical studies show that, while more heat may be 
created under its influence, so much heat is dissipated that the tempera- 
ture nevertheless falls. 

Bodily Metabolism. — The quantity of carbonic acid given off 
by the body under the use of alcohol is in most instances increased, 
but it may be decreased. The effect on the absorption of oxygen is 
not known. Some observers have noted an increase, some a decrease, 
of such absorption, and some no change at all when alcohol is taken. 
Upon the giving off of nitrogenous substances it acts as a decided depres- 
sant, which seems to prove that it inhibits rapid tissue-changes and is a 
conservator of vital power. It adds force, but not tissue, to the body. 

Elimination. — Alcohol is rapidly absorbed and rapidly destroyed 
by or eliminated from the body. In medicinal doses it is largely "burnt 
up"; but when taken in excess of the body's oxidizing power it is 
eliminated by the breath and by the skin, kidneys, and intestines. 

Digestion. — Alcohol added in any amount to food in a test-tube 
containing digestive ferments retards or inhibits digestion, but in the 
stomach, on the other hand, when used in moderation, it assists the 
process ; for by reason of its irritant and stimulating properties it 
induces the secretion of an excess of the digestive juice. When exces- 
sive amounts are ingested it disorders digestion by inhibiting the action 
of the digestive ferments. 

Therapeutics. — The employment of alcohol in disease can here be 
only briefly alluded to, special mention of its indications being named 
when the diseases in which it is used are discussed. (See Part IV.) 
Its chief uses are as a rapidly-acting stimulant in all forms of cardiac 
failure due to shock or to poisons, and as a systemic support and stim- 
ulant in low fevers and prolonged wasting diseases, in old age, and in 
convalescence from acute disease. In both croupous and catarrhal 
pneumonia alcohol is useful, and particularly is this true when these 
affections occur in children. (See Pneumonia, Part IV.) 

Some additional conditions, to state them specifically, in which 
alcohol is indicated are fainting, snake-bite, surgical shock, and chronic 
pneumonia in its later stages, and excessive toasting due to prolonged 
suppuration. It is also useful in poisoning by depressant drugs, such 
as aconite or antimony. 

Alcohol should never be given in the presence of circulatory excite- 
ment, but whenever the circulation fails during the progress of an 
acute disease it is useful. In the pneumonia of children, whether it 
be croupous or catarrhal, brandy or whiskey is very useful in the dose 
of 5 to 60 minims (0.3-4.0) every two hours in a little water or milk. 
(See Administration.) In exhausting fevers, such as typhoid or typhus, 
alcohol finds its true usefulness. While it is well to give alcohol in 
many cases of enteric fever from the beginning to the end of the attack, 
for the double purpose of aiding digestion and of supporting the system, 



64 DRUGS. 

its administration should not be a mere matter of routine, but should 
be based upon clear ideas of the indications it is calculated to fulfil. 
If the pulse is weak and the patient seems to be sinking, or the appe- 
tite is tailing and adynamia is a pressing symptom, alcohol is indi- 
cated ; but if the pulse is good, and the passage of the patient through 
his illness is not a stormy one, alcohol should be excluded from the 
sick-room. Sometimes ordinary whiskey or brandy will in severe 
typhoid fever disorder the stomach. The physician should then em- 
ploy an old brand}* or wine which has acquired an aroma which is 
called a "bouquet." 

In persistent vomiting small doses of good brandy poured on 
cracked ice will often do much good. 

Alcohol is not only of service internally, but it is also useful exter- 
nally as a wash or evaporating lotion over bruises, inflamed joints, 
and wounds of a contused character. It acts as a cooling and anti- 
septic dressing. It is also useful for washing the skin of invalids, and 
"salt and whiskey" applied by rubbing is a good mixture to stimu- 
late the skin of unhealthy persons. 

Acute Poisoning. — In advanced poisoning by alcohol, with coma 
and total relaxation, external heat and hypodermic injections of digi- 
talis and strychnine are indicated if the heart or respiration seems to 
be foiling- Belladonna should be administered to stimulate the vaso- 
motor system if the skin is relaxed and clammy, and counter-irrita- 
tion to the back of the neck is to be employed if any brain symptoms 
are pressing. The after-treatment consists in the use of substances 
stimulating to the stomach, such as ammonia, spirit of Mindererus, 
and spices, unless there is gastric inflammation, when emollient sub- 
stances should be used to quiet the irritation. If persistent vomiting 
comes on, it must be quieted by the patient swallowing pieces of ice, by 
aconite, cocaine, or minute doses of ipecac. Counter-irritation should 
be applied over the belly. If the emunctories are not acting freely, 
thorough purgation by jalap or elaterium (40 grains (2.6) of jalap 
powder or ', of a grain (0.01) of elaterium should be employed); or full 
of calomel followed by a saline may be given if milder effects 
are sought. For the morning vomiting of drunkards Fowler's solution 
of arsenic is often a valuable remedy. 

In view of the frequency with which alcoholic and opium poison- 
ing arc confused, the following table is appended, which will be found 
of value in making a differential diagnosis as to the condition of the 
patient : 

Alcoholism and Opium Poisoning. 
. I Icoholism. Opium Poisoning. 

1. Pupils normal or dilated. 1. Pupils contracted. 

'-'• Respiration nearly normal. Pulse 2. Inspiration and pulse slow and full. 

rapid, and finally feeble. 

:; Face maj be pallid. :;. Face suffused and cyanosed. 

I. Skin cool, perhaps moist 4. Skin wanner than in alcoholic poi- 

soning. 

•"»• Pake rapid, at first strong, then 5. Pulse slow, strong, and full till late 

in poisoning. 

There i scar< ely any difference ae to consciousness in the two conditions. 

In medico-legal cases the urine should be saved in hermetically sealed vessels for 



ALCOHOL. 65 

Acute Alcoholism and Apoplexy. 

Alcoholism. Apoplexy. 

1. Pulse rapid, compressible, and weak. 1. Pulse apt to be strong and slow. 

2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 

3. Bodily temperature lowered. 3. Bodily temperature raised. 

4. Pupils equally contracted or dilated; 4. Pupils unequal, 
generally dilated. 

5. No hemiplegia. 5. Hemiplegia : one side tossed, the 

other remaining motionless. 

6. Breathing not so stertorous nor so 6. Eespiration stertorous, the lips being 
one-sided in lips. inflated on one side on expiration. 

7. No facial palsy. 7. Facial palsy. 

8. Unconsciousness may not be com- 8. Unconsciousness complete, 
plete. 

The smell of alcohol in the breath is no guide, as acute alcoholism may have caused 
the rupture of a cerebral blood-vessel. 

Chronic Poisoning, or the Alcohol Habit. — Chronic poisoning by 
alcohol results in very characteristic changes in the tissues. As the 
liver receives the alcohol from the stomach diluted only by the portal 
blood, it is often affected very early, and cirrhosis of this organ comes 
on with its accompanying gastric and nutritional symptoms. Mental 
disturbances are common, and neuritis may develop in its painful forms 
or produce paralysis or symptoms resembling locomotor ataxia. 1 The 
treatment of chronic alcoholic poisoning may be carried out in two ways : 
First, by the isolation of the patient and the complete withdrawal of the 
drug at once ; secondly, by a better plan, a gradual tapering-off in the 
daily amount of the spirit. In either instance isolation must be abso- 
lute, and all smuggling of alcohol to or by the patient prevented. The 
attendants must be absolutely trustworthy. Careful scrutiny of bed- 
clothes and closets will often be rewarded by finding hidden whiskey- 
bottles. The depression of the patient when recovering from alcohol- 
ism must be met by the use of nutritious broths, highly seasoned in 
order to stimulate the stomach, by easily digested or predigested foods, 
and by small doses of morphine or coca if the patient be very weak 
and need such a stimulus. Koumyss is an exceedingly valuable and 
nutritious preparation under these circumstances. 

In the treatment of the atonic stomach of drunkards nothing does 
so well as the following pill : 

R. — Oleoresin. capsici tt\,x(0.65). 

Olei caryophylli tt\,x (0.65). 

Hydrarg.chlor. mit gr. xx (1.3). 

Aloes Socotrinse gr. xl (2.6). — M. 

Ft. in pil. No. xx. 
S. — One three times a day after or before meals. 

If this pill fails to move the bowels, a saline purgative should be used. 
The following are the principal points in the differential diagnosis of 

Chronic Alcoholism and the General Paralysis of the Insane. 
Alcoholism. Paretic Dementia. 

1. Attacks shorter, and more widely 1. Attacks more prolonged, 
separated by intervals of sanity. 

2. Delirium may be of any character. 2. Delirium of grandeur more marked 

and defined. 

1 See author's work on Diagnosis, Lea Brothers & Co., Philadelphia. 
5 



66 DRUGS. 

Alcoholism. Paretic Dementia. 

3. Visions more characteristic, and are 3. Visions often not evil, but pleasant, 
evil. 

4. Tremors confined to head and arms. 4. Tremors more diffused. 

5. Tremors removed bv dose of alco- 5. Tremors made worse by alcohol. 
hoi. 

6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol, 
moved, or at any rate improved, by al- 
cohol. 

7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- 
ing, ing. 

There is danger of pneumonia from failure of the right side of the 
heart in subacute and chronic alcoholism, and the physician should 
always be on the lookout for this complication. 

Administration. — Brandy and whiskey are generally used as rapidly- 
acting stimulants. They should be exhibited in the form best adapted 
to the work they are intended to perform. If the action must be 
instantaneous, as in a case of fainting, they should be employed hot 
and concentrated, so that the stomach has not to warm the liquid 
before absorption. They are to be used hypodermically if still more 
rapid action is required. If administered to aid digestion and support 
the system, then they should always be given ivith the food — never 
alone, and never concentrated. They may be given as milk-punch or 
as eggnog, the latter being the "heavier " of the two so far as diges- 
tion is concerned. In fevers of a typhoid type the dose of whiskey or 
brandy should be for an adult from { to 2 ounces (15.0-60.0) every 
three or four hours. More than a pint in twenty-four hours is rarely 
required, but this amount often does great good and is not excessive 
if the patient is accustomed to its use and needs stimulation. When 
brandy or whiskey is given to children, the following rules as to 
dosage may be used as indicating the approximate proper dose: 5 to 
lu minims (0.32-0.65) every four hours for a child of 1 month old; 
10 to 20 minims (0.65-1.30) for a child of 2 months old; 20 to 30 
minims (1.3-2.0) for a child of 3 months old ; 30 to 40 minims (2.0-2.6) 
for a child over 3 months old; 60 minims (4.0) for a child over 4 
months old. In some cases, how T ever, it is w r ell to use half these doses 
every two hours. In all cases the liquor should be diluted w^ith hot 
or cool water. Wine-whey is very light and useful. Mulled wine 
and champagne are particularly useful in the treatment of irritable 
stomach. (See Foods for the Sick.) Champagne when used as a 
medicinal Btimulanl should always be as devoid of sugar as possible — 
that Is, what is known as "extra dry" or "Brut." Gin is rarely 
employed as a stimulant, except when the kidneys are torpid. Stout 
and porter are of value in wasting diseases, in convalescence from 
acute diseases, and for nursing women. 

Contraindications. — All Btates of cerebral excitement, unless due 
to exhaustion, acute inflammations, the alcoholic habit, apoplexy, 
meningitis, acute nephritis, aneurism, and advanced atheroma, con- 
traindicate the use of alcohol, as does also the history of the alcoholic 
habit. 



ALLIUM. 67 

The official preparations of alcohol are as follows : 

Whiskey (Spiritus Frumenti, U. S.) should be at least three years 
old, and be made, in America, from rye for medicinal purposes. 

Brandy (Spiritus Vini Gallici, U. S. and B. P.) is obtained by the 
distillation of fermented grapes or fruits, and should be from three to 
five years old before use. 

Cologne-water (Spiritus Odoratus) is used solely as a lotion and 
perfume. 

Red Wine( Vinum Bubrum, U. S.) is made from grapes not deprived 
of their skins. White Wine (Vinum Album,) is the fermented juice 
of grapes the skins of which have been removed. 

Dilute Alcohol (Alcohol Dilutum, U. S.), deodorized alcohol 
(Alcohol Deodoratum, U. S.), pure alcohol (Alcohol, U. S.), and abso- 
lute alcohol (Alcohol Absolution, U. S. and B. P.) are also official. 

The unofficial preparations are : 

Rum, which is made from the fermentation of molasses, and con- 
tains about 40 to 45 per cent, of alcohol. 

Gin is made from rye or barley, with the addition of juniper-berries 
and hops. (Good gin and the Spiritus Juniperi Compositus of the 
U. S. Pharmacopceia are virtually identical therapeutically.) When 
diuresis is required and atony of the kidneys is present, without 
inflammation, gin is a useful medicament, provided that a stimulant 
is indicated. Gin is one of the alcoholic drinks most apt to produce 
cirrhosis of the liver. 

Port Wine ( Vinum Portense) is a fermented wine, to which pure 
spirit is added to increase its strength. It is one of the strongest table 
wines, and is useful as a stimulant in convalescence. 

Sherry ( Vinum Xericuni) has about 30 per cent, of alcohol in it. 
It is not official in the U. S. P. 

Beer is made by a slow fermentation, while ale is made by a more 
rapid fermentation at a higher heat. Most of the beer in America 
contains about 4-6 per cent, of alcohol. 

Porter resembles the other malt liquors closely, except that it 
contains more solids, due to a scorching of the grain by a high 
heat. 

The B. P. preparations that are not official in the U. S. P. are 
rectified spirit (Spiritus Bectificatus), sherry ( Vinum Xericuni), and 
Mistura Spiritus Vini G-allici, which is a useful, pleasant, and nutri- 
tious stimulant made by beating up the yolks of two eggs with half 
an ounce of sugar, and then adding four ounces each of brandy and 
cinnamon-water. This is sometimes called " egg-flip." 

ALLIUM. 

• 

Garlic, or Allium Sativum, U. S., is a stimulant to digestion, owing 
to the volatile oil it contains, which by its somewhat irritating proper- 
ties excites the gastric mucous membrane to increased secretion. In 
persistent colds, where the bronchial tubes are particularly affected, a 
garlic poultice, made by pounding the bulbs in a mortar, is a very 
efficient though disagreeable remedy. If the skin in any case is too 



68 DRUGS. 

delicate to permit of the use of pounded garlic alone, it may be mixed 
with equal parts of bran, and a regular poultice or plaster made 
thereof. Employed in this form, allium is useful if applied over the 
spine or feet in the treatment of the cerebral and spinal convulsions 
of infants; placed over the belly in cases of g 'astro-intestinal catarrh, 
it acts almost as well as a spice poultice. In the treatment of children 
with chronic colds garlic may be used boiled in milk, and the liquid 
L r iven as a drink, warm or cold; or the oil of garlic may be given in 
emulsion in the dose of 1 or 2 minims (0.06-0.12). It ought not to 
be given during the febrile stage, as it is stimulating. Allium-juice 
lias also been used in the dose of 2 to 5 drops (0.1-0.3), to relieve 
nervous vomiting. The dose of the syrup (Syrupus Allii, U. S.) for 
a child is 1 drachm (4.0), but 4 drachms (15.0) may be given to an 
adult. 

ALLSPICE. 

Allspice, or Pimento. (U. S. and B. P.), is the nearly ripe fruit of 
Pimento, officinalis, a tree of the West Indies. It contains an official 
volatile oil (Oleum Pimento?, U. S. and B. P.). used for flavoring 
purposes, as a constituent of spice plasters, in diarrhoea mixtures, or 
as a carminative. It will also prevent the griping of purgative 
medicines. The dose of the oil is 1 to 5 minims (0.06-0.30). Aqua 
Pimento? (B. P.) is given in the dose of 1 to 2 ounces (30.0-60.0). 

ALMONDS. 

Almonds are official in the form of the bitter almonds (Amygdala 
Amara,U. S. and B. P.) and the sweet almonds (Amygdala Dulcis, 
U. S. and B. P.). Bitter almonds develop hydrocyanic acid in the 
presence of water, by the reaction between the amygdalin and water 
in the presence of the emulsin contained in them ; this is not the 
with sweet almonds. 

Sweet almonds, when rubbed up in a mortar with water, form a 
pleasant-tasting emulsion of an agreeable odor that is very useful as a 
vehicle for remedies having a disagreeable taste. Almond bread has 
been proposed as a fond for diabetics, owing to its containing virtually 
no starch : but it is requisite that the oils and saccharine constituents 
of the almond shall first be removed. (See Foods for the Sick.) 

W hen half an ounce of sweet almonds are rubbed up with thirty 
grains of gum arahic and two drachms of sugar, to which is added 
gradually a half-pint of distilled water, the mixture being then 
-trailed, an emollient and soothing drink is formed, which is very 
useful in irritations of the stomach and intestines and of the air-pas- 
sages an<\ pharynx. The expressed or fixed oil of almonds is a useful 
demulcent, and has been recommended in the cough of phthisis, given 
in the dose of B \ drachm (2.0) in emulsion. 

Bitter almonds give off an oil {Oleum Amygdala Amarce, U. S.) 
which is exceedingly poisonous, owing to the prussic acid which it 
contains, and it is said that one drop will kill a cat, while seventeen 
drops ha\ e killed a man. 



ALOES. 69 

Bitter almonds are used to allay irritable coughs and similar states, 
but are not frequently employed, because other drugs are less danger- 
ous, more stable, and more active as remedial agents. The emulsion 
of bitter almonds is made as is that of sweet almonds, and may be used 
in teaspoonful doses for the same purposes and as a vehicle in cough 
mixtures. Both emulsions are useful as vehicles in the treatment 
of gonorrhoea, as they diminish the burning on urination. Almond 
emulsions, when locally applied, are supposed to be of value for the 
removal of freckles and sunburn. 

The preparations of sweet almonds are : an emulsion (Mnulsum 
{Amygdala?, TJ. 8., and Mistura Amygdala, B. P.), dose 1 to 2 ounces 
(30.0-60.0); a syrup {Syrupus Amygdala?, TJ. 8.), dose 2 drachms to 
2 ounces (8.0—60.0); a compound powder {Pulvis Amygdalce Composi- 
tus, B. P.), given in the dose of 1 to 2 drachms (4.0-8.0); and the 
oil {Oleum Amygdala? Expressum, TJ. S., and Oleum Amygdala, 
B. P.), the dose of which is 1 to 4 drachms (4.0-16.0). Aqua? Amyg- 
dala? Amara? { TJ. S.) is prepared from the oil of bitter almonds. The 
dose is 30 to 60 minims (2.0-4.0). 



ALOES. 

Aloes, or Aloe of the TJ. S. P., is derived from Aloe Perryi, or 
Aloe vera. In the U. S. P. of 1890 the first is called Socotrine aloes 
{Aloe Socotrina, TJ. S. and B. P.), the second Barbadoes aloes {Aloe 
Barbadensis, TJ. S. and B. P.). Aloes is the inspissated or dried 
juice of the leaves of the plant. It is also probably derived from 
several other species than those just named. Aloes contains an active 
principle known as aloin {Aloinum, TJ. S. and B. P.), which is a 
crystalline substance. As aloin is generally sold it is, however, an 
amorphous powder of extremely bitter taste. 

Physiological Action. — Locally applied to the tongue, aloes is a 
bitter of rather a persistent taste. According to the studies of Ruther- 
ford, the drug increases very considerably the flow of bile in the dog, 
but in man it cannot in any sense be regarded as a medicament for the 
production of an increased biliary flow. Rutherford's doses given to 
the dog amounted to as much as sixty grains, equal to three or four 
drachms in man. In the lower animals and in man aloes acts very 
slowly, requiring many hours for its influence to be distinctly felt, un- 
less the dose be toxic in amount. Its chief influence is on the lower 
bowel (Fig. 4). As much as four drachms of aloes have been injected 
into the veins of a horse without inducing purgation, probably because 
four drachms were not enough to affect the bowels. Aloes has been 
used endermically, and when so employed is said to act thoroughly. It 
is eliminated in the milk of nursing women, and will cause purgation 
in an infant put to the breast of a patient taking it. If the doses be 
quite large (10 to 20 grains), the passages will be watery ; but if the 
dose be more moderate (2 or 3 grains), the stools will be thick and 
pultaceous. 

Therapeutics. — Aloes should be used only when a somewhat slow 



70 



DRUGS. 



stimulant to peristaltic movement is desired, and never where the 
object of the physician is to relieve congestions by depletion through 
the intestine. It is a favorite remedy in cases of subacute or chronic 
constipation, but it is distinctly harmful if continued for any length 
of time, as it seems to produce atony of the bowel. Owing to its bit- 
ter properties it acts as a tonic to the stomach, and is often given with 
iron to promote the absorption of this metal by stimulating the liver 
and by preventing any constipation which might be produced by the 
chalybeate. 

When taken in a large enough dose to produce a copious passage, 
aloes nearly always produces a feeling of weight and fulness in the 
region of the rectum after the evacuation, and the writer has seen 
severe rectal catarrh produced in this way. If given alone it is very 
apt to produce griping, and it ought always to be combined with 
other drugs whose tendency is to prevent intestinal spasm. 

Fig. 7. 




A, Chief effect of aloes is exercised on lower bowel or colon. 

In cases of hcemorrltoids occurring in persons suffering from gen- 
eral muscular relaxation and atony, aloes is said to do great good, 
bul its use under these circumstances is by no means universal or 
generally accepted as correct. For weak, anaemic persons leading 
sedentary lives it may be combined with tonics to relieve the consti- 
pation bo often a pressing symptom in these cases. In amenorrhea 
dependent upon atony of the sexual system, or anaemia, or constipa- 
tion, it is thought to have a specific emmenagogue influence. Locally 
applied in the form of the glycerole of aloes, it has been employed 
in the healing of old or new fissures of mucous membranes, and even 
in bed-sores. The glycerole of aloes is to be made by evaporating 
four to eight parts of tincture of aloes and gradually adding thirty 
part- of glycerin. 

Contraindications. — Constipation occurring in plethoric persons 
Bhould not be treated by aloes, and it should not be used if any 






ALUM. 71 

irritation or catarrh of the intestine is present. Pregnant women 
should use aloes most carefully, lest abortion be produced, and if 
hepatic congestion or inflammation is present it ought not to be used. 
Fever is said to contraindicate the use of aloes, as does also rectal 
catarrh. 

Administration. — Aloes is generally given in a pill, combined with 
spices and belladonna. (See Constipation, Part IV.) The dose should 
be about 1 to 5 grains (0.06-0.3) as a laxative, and 10 grains (0.5) as 
a purge. The Aloe Puriftcata, TJ. S. P., should always be used. The 
official preparations most commonly employed are the pill of aloes 
(Pilulce Aloes, TJ. S. and B. P.), 2 grains (0.13) each of aloes and 
soap ; the pill of aloes and myrrh (Pilulce Aloes et Myrrhce, TJ. S. 
and B. P.), 2 grains (0.12) of each constituent; the pill of aloes and 
mastich (Pilulce Aloes et Mastiches, TJ. S.), 2 grains (0.13) of aloes, 
or the "Lady Webster dinner pill;" the pill of aloes and iron 
(Pilulce Aloes et Ferri, TJ. S. and B. P.), 1 grain (0.06) of aloes and 
1 grain (0.06) of dried sulphate of iron; and the pill of aloes and 
asafoetida (Pilulce Aloes et Asafceticlce, TJ. S. and B. P.), containing 
4 grains (0.26) of aloes, asafoetida, and soap. The dose of all these 
is one or two pills. Aloes is also official as Extraeturn Aloes Aquo- 
sum, dose 1 to 2 grains (0.06-0.12). The liquid preparations are the 
tincture (Tinctura Aloes, TJ. S. and B. P.), dose 1 to 2 fluidrachms 
(4.0-8.0); the tincture of aloes and myrrh (Tinctura Aloes et 
Myrrhce, U. S.), 1 dose 1 to 2 fluidrachms (4.0-8.0). The B. P. 
preparations, besides those given, are the Deeoctum Aloes Compositum, 
dose \ to 2 ounces (15.0-60.0); and the Extraeturn Aloes Barbadensis, 
the dose of which is 2 to 6 grains (0.1-04.) 



ALUM. 

Alum (Alurnen, TJ. 8. and B. P.) is the sulphate of aluminum and 
potassium in the TJ. S. P., but in the B. P. both it and the sulphate 
of aluminum and ammonium crystallized from a watery solution are 
official. At present much of the alum of commerce is made in the manu- 
facture of coal-gas for illuminating purposes, and it is therefore very 
cheap. It occurs in the form of octahedral crystals, and has an astrin- 
gent taste and acid reaction. After the crystals are exposed to the 
air for some time they become covered with a white coating. 

Physiological Action. — When alum is brought in contact with a 
mucous membrane it produces whitening, constriction, and puckering 
of the part, and applied to the skin thickens and toughens it by 
means of its astringent action. In either case it decreases secretior 
and causes contraction of the local blood-vessels and capillaries. 
Large amounts given for any length of time seem to increase secre- 
tion. 

Poisoning. — Very large amounts are necessary to produce death. 
As much as two ounces will not kill a sickly dog. This is largely 
due to the fact that the vomiting and purging rid the animal of the 
1 Sometimes called Elixir Proprietatis. 



72 DRUGS. 

drug, for if vomiting is prevented death rapidly ensues from gastro- 
enteritis. Injected into the blood, alum produces embolism and 
thrombosis. 

Therapeutics. — Alum is used at present in a number of diseases, 
chiefly as a local application. In cases of ordinary sore throat appli- 
cations of a strong solution (20 grains to the ounce of water — 1.3- 
30.0) on a swab will be found very useful. It would be of much service 
in this condition were it not that it posseses a destructive action on the 
teeth. In hemorrhage, when the leaking blood-vessels can be directly 
reached, alum is a remarkable hemostatic, aiding in the arrest of the 
bleeding in three ways — namely, by coagulating the albumin, by con- 
stringing the parts, and by crystallizing when applied in large amounts 
on lint, and thereby affording a surface which is rough and aids coagu- 
lation. In hemorrhage after tooth-extraction its application is a very 
useful treatment. Dissolved in water or alcohol, 2 grains to the ounce 
(0.1 to 30.0), it makes an exceedingly efficient application for sponging 
in night-sweats or localized siveating of the feet or hands. In hcemop- 
tysis a fine spray of a strong solution of alum, 20 grains to the ounce 
(1.3-30.0), may be employed, the necessity of the spray being made 
very fine being constantly borne in mind. This method may also be 
resorted to in bronchorrhoea or chronic bronchitis with excessive secre- 
tion, and in chronic catarrh of the pharynx and larynx. In mercurial 
ptyalism the drug may be used on a swab. Bathing the parts affected 
with an alum solution is said to be an efficient remedy in chilblains, and 
even for pruritus vulva?. As a vaginal wash for excessive leucorrhoea, 
in the strength of from 10 to 20 grains to the ounce (0.65-1.3 to 30.0) 
of water, alum is of value. Some observers claim good results from its 
use in diphtheria and tonsillitis. In follicular tonsillitis the alum-stick 
may be deeply inserted into the depressed follicles or applied to the 
swollen surface of the gland. In ingrowing toe-nail with granulations 
a piece of twisted absorbent cotton soaked in strong alum solution and 
inserted under the edge of the nail will in most instances do a great 
deal toward a cure. Dried alum (Alumen Exsiccatum, U. S. and B. 
P.) is useful as a dressing for old ulcers and sores, and has been 
highly recommended as an application -x>r swollen gums where they 
press upon and override a tooth, particularly at the back of .the jaw. 
The possibility of its exercising an evil effect on the teeth should not 
be forgotten when this treatment is resorted to. 

[nternally, alum lias been used in diabetes, gastralgia, and dysen- 
tery of an acute and chronic: type. In lead colic it seems to be of 
value in conjunction with morphine to allay the pain. At one time 
alum was largely employed in membranous croup in emetic dose for 
the dislodging of the membrane and for the astringent effect exer- 
cised as it waa swallowed and expelled. 

The emetic dose of powdered alum is a heaping teaspoonful for a 
child or a tablespoonful for an adult. 

Alum may be used as an antidote in acute lead-poisoning, as it is 
:i soluble sulphate and alao an emetic. 

Glycerinum Aluminis (1 to 5) Is official in the B. P., and is used 
em b local astringent application. 



AMMONIA. 73 



AMBER. 



Succinum is derived from a fossil resin found in Prussia and 
Bohemia, and is used in the form of the oil {Oleum , Sue cini), which 
is volatile, quite irritant, and obtained by destructive distillation from 
the deposits named. 

Therapeutics. — Oil of Amber is one of the best remedies for per- 
sistent hiccough that we have. It is very useful as a counter-irritant 
over rheumatic joints, and has been used in asthma, whooping cough, 
and hysteria with good results. In the bronchitis of infants, with 
nervous disturbance, oil of amber in the proportion of 1 to 3 parts 
of olive oil applied to the back and front of the chest is of service. 
In adults suffering from acute laryngitis with an extension of the 
inflammation into the bronchial tubes full doses of sodium bromide 
given internally, with this proportion of amber oil and olive oil 
rubbed into the neck and chest, are very useful. The dose internally 
is 2 to 6 minims (0.1-0.4) given in emulsion. 

AMMONIA (NH 3 ). 

Ammonia is a gas of a very acrid, burning taste and sensation, 
capable of producing death very rapidly, when inhaled, by reason of 
the inflammation of the air-passages and the spasm of the glottis which 
ensue. It is made in large amounts in the manufacture of coal-gas. 

Physiological Action. — When ammonia comes in contact with the 
tissues of the body it acts as a most powerful irritant, causing a red- 
dening of the parts, followed, if the exposure be long enough, by 
local death and sloughing. If it be inhaled as a gas, it may produce 
rapid death by spasm or oedema of the glottis, and if a strong solution 
of it is swallowed, the same accident may occur. After more moderate 
inhalations severe bronchitis or pulmonary oedema may develop. 

Nervous System. — If ammonia be injected into the blood of 
animals, violent convulsions at once ensue which are largely tetanic 
in type and depend upon a spinal action of the drug, since they are 
not stopped by division of the spinal cord, as they would be if the con- 
vulsive movements had their origin in the brain. The drug in moder- 
ate amounts acts as a spinal excitant, increasing reflex action and all 
the evidences of spinal activity. If applied directly to a nerve, either 
motor or sensory, it paralyzes it, but if the drug be in very weak solu- 
tion, it seems to increase its functional activity. 

Circulation. — Upon the circulation ammonia acts as a powerful 
but fleeting stimulant, increasing the pulse-rate, pulse-force, and arterial 
pressure. The cause of the increased pulse-rate depends upon stimula- 
tion of the accelerator nerves of the heart and of the heart itself, while 
the increase in force is due to the same cause, for Ringer and Sainsbury 
found the strength of the ventricles much increased. The rise of arte- 
rial pressure is due to the increased amount of blood pumped into the 
arteries by the stimulated heart, and probably by a stimulant action on 
the vaso-motor centre, although it is stated by some authorities that this 
is not so. As the drug acts as a stimulant on the respiratory centre, 



74 



DRUGS. 



which is very near the vasomotor centre, it probably increases the 
functional activity of both. If by means of intravenous injection 
the ammonia reaches the heart in large amount in concentrated 
form, this organ ceases to beat at once, owing to paralysis of its 
muscular walls. 

The Blood. — In moderate amounts the drug has no effect on the 
blood, but when injected in poisonous quantities it causes the blood to 
fail to take up the oxygen, according to Feltz and Hitter. 

Respiration. — The injection of ammonia in moderate quantities 
into the blood causes an acceleration of the rate of respiration due to 
a stimulation of the respiratory centre, the respiratory movements 
becoming not only more full, but more rapid. If the drug is inhaled 



Fig. 8. 




Ammonia stimulates: A, the accelerator nerves; B, the heart-muscle itself, and so quickens 
pulse-rate and force. It stimulates the vasomotor centre Cand the respiratory centre D. 

in small amounts or swallowed, the same action is seen in a less degree, 
the changes both, in breathing and circulation being partly due under 
siidi circumstances to a reflex irritation transmitted along the sensory 
nerves. 

Elim [NATION. — Ammonia when taken into the body is so extremely 
fleeting in its action that the question as to its escape from the system 
is of interest. Jf large amounts are taken, it is partly given off by 
the breath, bu1 more of it is burnt up in the system, and, according to 
Bence .Jones, eliminated as nitric acid by reason of its being oxidized 
in the body. Some think thai it is in part excreted as urea. 

Therapeutics. — Ammonia is employed for four distinct purposes in 
medicine — namely, as a circulatory and respiratory stimulant, as a 
counter-irritant, and as an antacid. 

The indications for the use of ammonia in the first class of cases 
are all forms of sudden cardiac failure where there is no time or 
opportunity to use the more stable and slowly-acting drugs. These 






AMMONIAC. 75 

emergencies occur in snake-poisoning, in syncope from fright or other 
shock or indigestion, in sudden cardiac failure during the course of 
fevers and in pneumonia, and in all cases where rapid cardiac stim- 
ulation is needed. It is claimed, without great justification, that ammo- 
nia will aid in preventing heart-clot or thrombosis in cases of severe 
hemorrhage and in pneumonia. In the most pressing cases it should 
be injected directly into the vein of the leg, so as to act more quickly. 
If put into the subcutaneous tissues, it is almost certain to make a 
slough, and if injected into a vein of the arm, it may reach the heart 
in too concentrated form and cause cardiac depression. Ringer has 
found that the drug has the extraordinary power of causing a heart 
stopped or depressed by chloroform to return to its beating. 

In prolonged diseases the employment of ammonia is not particularly 
advisable, owing to its fugacious action, although it is largely used, for 
the frequent administration necessarily required is apt to produce gastric 
disorder. Some persons claim that ammonia is useful as a sedative in 
drunkenness, but this is doubtful. 

In gastric acidity due to fermentation, with the development of 
abnormal acids, ammonia is the most active remedy we can employ, but 
is not to be given if acute irritation of the stomach exists. 

Locally applied, strong ammonia-water may be used to produce a 
blister by placing a few drops on the skin under an inverted watch- 
glass. Ammonia-water may also be applied, often with great relief, 
to the spot stung by insects. The waters of ammonia are used exter- 
nally in stimulating liniments, and hypodermically when the drug is 
so given. The stronger water ought not to be employed for the latter 
purpose. The aromatic spirit is generally used internally in the dose 
of ^ drachm to 1 drachm (2.0-4.0), well diluted. This is also the 
dose of the ordinary spirit. 

Administration. — Ammonia is never employed in medicine as pure 
ammonia gas, but in the form of the stronger water (Aqua Ammonice 
Fortior, U. S. ; Liquor Ammonice Fortis, B. P.), containing 28 per 
cent, by weight of the gas, and the weaker water (Aqua Ammonia?, U. S. ; 
Liquor Ammonice, B. P.), which should contain about 10 per cent, 
by weight of the gas. The spirit of ammonia (Spiritus Ammonia?, 
U. S.) is given in the dose of 30 to 60 minims (2.0-4.0) in water, 
and the aromatic spirit of ammonia (Spiritus Ammonice Aromaticus, 
U. S. and B. P.) in the dose of 30 to 60 minims (2.0-4.0) in water. 
The latter preparation is composed of carbonate of ammonium, the 
oils of nutmeg, lemon, and lavender, with alcohol and ammonia-water. 
Spiritus Ammonice Fetidus (B. P.) contains asafoetida and is used in 
place of the aromatic spirit. Ammonia liniment (Linimentum Am- 
monice, U. S. and B. P.) is used over tender joints and muscles. 

AMMONIAC. 

Ammoniac (Ammoniacum, U. S. and B. P.) is a resinous gum 
obtained from Borema Ammoniacum, and is used very little in medi- 
cine at the present time. Internally and externally it produces some 
irritation when brought in contact with the tissues, and may be used 



76 DRUGS. 

internally in the dose of 10 to 30 grains (0.65-2.0) in pills in cases 
of chronic bronchitis devoid of any active inflammatory process. It 
is official in the form of the plaster of ammoniac and mercury (Em- 
plastrum Ammoniaci cum Hydrargyro, U. S. and B. P.), which is 
used as a stimulant over enlarged glands. Finally, there is the emul- 
sion of ammoniac (Emulsum Ammoniaci, U. S., and Mistura Ammo- 
niaci, B. P.), used in chronic bronchitis in the dose of a tablespoon- 

r.ii (15.0). 

AMMONIUM (NH 4 ). 

The following salts of ammonium are official, and are used for 
various purposes : 

Acetate of Ammonium. 

Acetate of Ammonium is used in medicine in the form of the 
spirit of Mindererus {Liquor Ammonii Acetatis, U. S. and B. P.), 
dose 1 to 2 fluidrachms (4.0-8.0), for the purpose of acting as an 
antacid in gastric indigestion, and also as a mild diaphoretic which is 
inferior to sweet spirit of nitre. 



Benzoate of Ammonium. 

Benzoate of Ammonium (Ammonii Benzoas, U. 8. and B. P.) is 
employed chiefly for its diuretic influences, which depend entirely 
upon the benzoic acid present in the compound. It should be kept 
in well-stoppered bottles. As benzoic acid is eliminated as hippuric 
acid and ammonia as nitric acid, this drug may be employed in cases 
where the physician desires to make the urine decidedly acid; as, for 
example, in patients suffering from catarrh of the bladder, when the 
urine is loaded with phosphates, w r hich are dissolved by this acidulation. 
The dose is 10 to 30 grains (0.5-2.0), which should be dissolved in 
water or, better, administered in cachets or capsules. 

Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) is 
really a crystalline salt, but is generally found in commerce as a Avhite 
granular powder, which, when exposed to the atmosphere, becomes 
slightly yellowish. It is readily dissolved in water. 

Physiological Action. — Applied to the mucous membrane of the 
mouth, the bromide of ammonium produces a salty taste, is markedly 
pungent, and dissolves readily in the oral secretions. If large amounts 
are swallowed, it causes burning pain in the belly and evidences of 
gastro-enteritis. 

Nervous System.— The action of this drug upon this part of the 

body is its most important effect. Given to the lower animals, it pro- 
due- in frogs total loss of reflex activity, preceded, it is said, in some 
cases by tetanic convulsions, although no such motor disturbances may 
take place. In a series of studies undertaken bv the writer to deter- 



AMMONIUM. 77 

mine the exact effect of the drug it was found that the spinal cord was 
depressed, both on its motor and sensory sides, while the nerves and 
muscles escaped. These results are in accord with those of other 
investigators, who also found that the nerves are unaffected. On the 
cerebral cortex it acts as a very distinct sedative. 

Cikculation. — -Upon the circulation bromide of ammonium acts 
as a stimulant in small doses, but as a cardiac paralyzant if a large 
amount comes in contact with the heart. In medicinal dose it is 
distinctly stimulant to the circulation, but not sufficiently so to render 
it valuable as a circulatory stimulant, to the exclusion of other more 
powerful preparations. 

Therapeutics. — The bromide of ammonium may be used in nearly 
every instance where bromide of potassium may be employed, and 
possesses the distinct advantage of being less depressant to the gen- 
eral system than the latter drug. It is, however, more apt to disorder 
the stomach even if given in moderate doses. In epilepsy it would 
seem to be of as much value as the potassium salt, and may be com- 
bined with it in some cases with success. (See article on Epilepsy, 
Part IV.) According to DaCosta, the drug is of very distinct value 
in rheumatism in the dose of 60 to 80 grains (4.0-5.3) a day, well 
diluted with water, although its manner of action in this disease is 
not known. The usual dose is 10 to 30 grains (0.65-2.0). It is 
incompatible with spirit of nitrous ether. 

Carbonate of Ammonium. 

Carbonate of Ammonium {Ammonii Carbonas, U. S. and B. P.) 
undoubtedly has an action exactly like that of the liquid preparations 
of ammonia, and is used either alone or with the chloride in the 
treatment of bronchitis, particularly when this disease occurs in babies 
and young children. It is also largely employed by surgeons in the 
treatment of children after a surgical operation to overcome the 
respiratory and circulatory depression produced by the anaesthetic. 
The dose is 2 to 10 grains (0.1-0.65) in syrup of acacia and water. 
It is a rapidly-acting cardiac and respiratory stimulant. 

R. Ammonii carbonat gr. xlviij (3.0). 

Syrup, acacise . f.^j (30.0). 

Aquae dest q. s. ad f.^iij (90.0).— M. 

S. — Teaspoonful (4.0) every two hours for a child of three or four years. 

Chloride of Ammonium. 

The Chloride or Muriate of Ammonium (Ammonii Chloridum, TJ. S. 
and B. P.) has an entirely different action and therapeutic use from 
the rest of this group. It possesses almost no influence over the heart 
and respiration, but does exercise a very stimulant effect on mucous 
membranes, increasing the secretion of mucus. The consideration of 
its use in diseases of the lungs can be found in the articles on Pneu- 
monia and Bronchitis. Chloride-of-ammonium fumes can be obtained 
from a few grains of the drug heated in an iron spoon over a gas-jet 
or by means of a set of three wash-bottles. In one of these is placed 



78 DRUGS. 

stronger water of ammonia, in the other muriatic acid. Each of these 
is connected with a third bottle by means of glass tubing, this bottle 
being partly filled with water, through which the fumes in passing 
become purified and form the fumes of chloride of ammonium. The 
drug mav also be used in a spray from an atomizer. Where it is 
desirable* to maintain the effect of the drug over a long period of time, 
as in chronic bronchitis, the following method may be followed, as 
recommended by Mew : A soup-plate is placed upon the floor of the 
room, and from 3 to 4 ounces (90.0-120.0) of sulphuric acid are placed 
in it. Into a neighboring saucer are poured 2 ounces (60.0) of strong 
ammonia, and then about a tablespoonful (15.0) of ordinary table-, 
salt is sprinkled upon the acid. In less than a minute the room 
becomes filled with dense fumes of nascent chloride of ammonium, 
which can be readily maintained by renewed charging of the soup- 
plate and saucer. In this way the patient may be made to inhale 
chloride of ammonium fumes for a long period of time with very ad- 
vantageous results. This is a particularly useful method in cases of I 
foetid bronchitis. 

Chloride of ammonium has been employed in intermittent fever, 
but has gone out of use, and has also been used in neuralgias of the 
ovarian type by Goodell and others. In the treatment of chronic 
torpor of the liver and subacute hepatitis, and even in cirrhosis and 
hepatic abscess, it has been thought of value. Many clinicians have 
found it useful in the treatment of the gastric and intestinal catarrhs 
of children of a very subacute type, and it is the routine treatment 
for all such cases which come under observation at the hospital and 
elsewhere where the author has charge. The dose is 2 to 15 grains 
(0.1— l.O), preferably given with liquorice and water to mask the taste : 

R. — Ammonii chloridi £ij (8.0). 

Extract, glvcvrrhiz. fl f^j (30.0). 

Aquae dest/ q. s. ad f§iij (90.0).— M. 

S. — Teaspoonfu] (4.0) t. d. after meals for a child of five to ten years. 

The chloride of ammonium may, however, be given in compressed 
tablets, provided a large draught of water or milk is taken simulta- 
neously to protect the stomach. (See article on Bronchitis for other 
prescriptions.) 

Gillespie asserts that 10 grains (0.65) of chloride of ammonium 
irivon half an hour before meals gives extraordinary relief in painful 
dyspepsia due to hyperacidity of the stomach. ' 

Chloride of ammonium, in a lotion in the strength of 1 ounce (30.0) 
to 2 quarts (2 litres) of water, is an efficient remedy for the derma- 
titis caused by poison-ivy. 



Iodide of Ammonium. 

[odide of Ammonium (Ammonii Todidum, U. S.) should be kept 
in dark, well-stoppered bo tiles, and if deeply colored should not be 
dispensed. It may be employed in the dose of 2 to 5 grains (0.1-0.3) 
in nil cases where the iodide of potassium is indicated, and seems to 



AMYL NITRITE. 79 

possess alterative influences equal to those of that salt. It has been 
recommended as a local application in cases of enlarged tonsils in the 
form of a solution of 30 grains (2.0) of the salt to the ounce (30.0) 
of glycerin, particularly if struma is the cause of the enlargement. 
The application is to be made once a day with a swab or camel's- 
hair brush. It is necessary that this solution be not exposed to the 
air or it will undergo decomposition. 



Valerianate of Ammonium. 

Valerianate of Ammonium (Ammomi Valerianas, U. #.) is the 
salt of ammonium commonly used in the nervous unrest of pregnant 
or hysterical women, or at the menopause in the peculiar nervous dis- 
orders apt to occur at that period. In poisonous doses it paralyzes 
the spinal cord in the lower animals. It is usually given in the form 
of the elixir of valerianate of ammonium, the dose of which is a tea- 
spoonful to a dessertspoonful, or it is combined with the bromides, 
under which circumstances it is much more efficacious. The dose of 
the salt itself is 10 to 15 grains (0.65-1.0). 

The sulphate of ammonium is never used in medicine. The phos- 
phate of ammonium is employed in rheumatism in the dose of 10 to 
20 grains (0.65-1.3). It is no longer official. 

The B. P. preparations besides those already given are : Oxalate 
of Ammonium, Liquor Ammonii Citratis, dose 2 to 6 fluidrachms 
(8.0-23.0). 

AMYL NITRITE. 

Amyl Nitrite {Amyl Nitris, U. S. and B. P.) is a very volatile,, 
somewhat oily liquid possessing a peculiar penetrating pear-like odor. 
It is made by the action of nitric and nitrous acids upon amylic alco- 
hol, and is not to be confounded with nitrate of amyl, which has a 
different physiological action and is never used medicinally. 

Nitrite of amyl should be protected from light, heat, and fire. 

Physiological Action. — When swallowed or inhaled the drug pro- 
duces staggering, fulness in the head, roaring in the ears, duskiness 
of the face, and finally utter muscular relaxation, so that the animal 
or man falls to the ground. The heart beats very rapidly and forcibly, 
and the respiration becomes gasping. 

Nervous System. — Nitrite of amyl acts as the most rapid of all 
the nervous depressants and sedatives known, except prussic acid. 
Experiments show that its dominant action is on the motor side of 
the spinal cord. The motor cortex of the brain and the motor nerves 
are only affected by large amounts. Upon the nervous apparatus of 
sensation nitrite of amyl has no effect in medicinal amounts, and can 
never be used to relieve pain unless it be due to spasm or tc angina 
pectoris. The muscles are depressed by toxic amount. 

Circulation. — When nitrite of amyl is used the pulse becomes 



80 



DRUGS. 



Fig. 9. 




>f 



V 



exceedingly rapid, while the arterial tension progressively falls. The 
increase in pulse-rate is due to depression of the centric inhibitory 
apparatus (vagus centres) of the heart and to the 
sudden relaxation of the blood-vessels, by reason 
of which, the resistance being taken away, the heart 
beats faster. The fall of arterial pressure is due to 
depression of the vasomotor centres and the mus- 
cular coats of the blood-vessels. In very small 
amounts the drug stimulates the heart-muscle 
(Reichert), but its dominant action is that of a 
depressant. 

The Blood. — In medicinal dose this drug pro- 
duces a chocolate color of the arterial blood, due to 
the change of oxyhemoglobin into methsemoglobin. 
Urine and Elimination. — The urine some- 
times contains sugar after the use of the nitrite of 
amyl, and there is increased diuresis. The drug is 
eliminated very rapidly from the body by the lungs 
and kidneys. 

Temperature. — If the nitrite of amyl be em- 
ployed for any length of time, a most remarkable 
fall in bodily temperature ensues, which is probably 
due to diminished oxidation, but possibly to some 
effect on the heat-centres governing heat-production 
The vascular dilatation also tends to greatly aid in 
the fall of bodily heat produced by the drug. 

Therapeutics. — Nitrite of amyl is used to relax general or local 
muscular spasms, for the relaxation of the spasm of epilepsy and for 
aborting an on-coming fit, for the prevention and subjugation of strych- 
nine convulsions and tetanus, and for the relief of angina pectoris, 
provided the attack is accompanied by high arterial tension. It may 
be used in puerperal eclampsia, but it is a dangerous remedy, because 
of* its relaxation of the uterus and the consequent danger of post- 
partum hemorrhage. In dysmenorrhoea with uterine spasm it often 
:i eat relief. Nitrite of amyl has been used in cases of sea-sick- 
uesa as a prophylactic and cure with considerable success. In cardiac 
failure from fright or anaesthetics amyl nitrite is often of great value 
in single \\ hill's. If it does not act at once under these circumstancs, 
it Is worse than useless to push it. It has also been found of value 
in whooping cough, laryngismus stridulus, asthma, spasmodic croup, 
and infantile convulsions. In migraine with local vasomotor spasm 
and true hemianopsia it is very useful. In strychnine poisoning and 
tetanus it musl be used between the spasms or else given hypodermic- 
ally, as the respiratory cramp prevents its inhalation. 

Administration. — The drug may be given by placing three to five 
drops on a handkerchief and inhaling the fumes, or it may be dropped 
on sugar and taken by the mouth in the same quantity. 

It is important to remember the fact that the effects of the drug 
are more severe for a momenl after its use than during its inhalation. 
The physician should wain the patient that the effect of the drug 



y 



Nitrite of amyl de- 
presses the "motor 
or crossed pyram- 
idal tracts of the 
spinal cord. 



and dissipation 



ANTIMONY. 81 

is sudden and alarming, and in nervous cases should direct that the 
inhalations be made gently, as a very full inhalation may produce 
unpleasant sensations of cardiac failure. 

The best way for patients to use the drug is to have it in pearls 
of glass, each holding 3 minims (0.15). One or more of these may 
be crushed in the handkerchief and the fumes inhaled. Some of the 
pearls made by careless manufacturers are of such thick, strong glass 
that they are difficult to break, and if broken are apt to cut the fin- 
gers. These are, of course, to be avoided. 

ANTHRAROBIN. 

Anthrarobin, which was originally discovered by Liebermann, 
seems to possess equal value with its relative chrysarobin, and to be 
capable of acting as efficaciously as this substance in the treatment 
of skin diseases. It is a yellowish powder, tolerably stable in a dry 
atmosphere, not soluble in acids or water, but readily soluble in dilute 
alkaline solution or alcohol, at first making a solution of a brown 
color, which, as oxygen is taken up, passes to a green and finally to 
a violet. 

Therapeutically, anthrarobin has been employed by Rosenthal and 
by Behrend, and more recently Kobner has recorded his experience 
with it, employing it with good results in a 10 to 20 per cent, solu- 
tion in the various forms of tonsurans as a wash. Rosenthal has used 
it in psoriasis and pityriasis versicolor and herpes, and Behrend asserts 
that it is often better in its effects upon the skin than chrysarobin, as 
it produces less inflammation and only discolors the skin slightly. It 
also possesses the additional value of making so slight a stain on the 
linen that it can be removed by washing. 

According to most authorities, it is best to keep the drug in alco- 
holic solution, and, if the bottle is well corked, such a mixture 
remains good for a week. 

ANTIMONY. 

Antimony itself is rarely used in medicine, owing to its insolubil- 
ity, but is generally employed as the tartrate of antimony and potas- 
sium, or Tartar Emetic (Antimonii et Potassii Tartras, TJ. S. ; Anti- 
monium Tartaratimi, B. P.), or in the form of the sulphide (Anti- 
monii Sulphidum, TJ. S.) ; purified sulphide (Antimonii Sulphidum 
Purificatum, TJ. S. ; Antimonium Nigrum Purification, B. P.) ; and 
sulphurated antimony (Antimonium Sulphuratum, TJ. S. and B. P.), 
sometimes called Kermes Mineral. The last three drugs are very 
rarely employed, and are unreliable preparations, although some prac- 
titioners use kermes mineral as an alterative circulatory depressant 
and sedative expectorant in the dose of \ grain (0.01) every hour or 
two. As an emetic the dose of Kermes Mineral is 1 to 4 grains (0.05- 
0.6). 

The oxide of antimony (Antimonii Oxidum, TJ. 8. and B. P.) 
forms part of the Pulvis Antimonialis. 



82 



DRUGS. 



Tartar Emetic. 

Tartar Emetic (Ant humid et Potassii Tartras, TJ. S. ; Antimonium 
Tartaratum, B. P.) is made by boiling the oxide of antimony with 
bitartrate of potassium and water. Although it is really crystalline, 
it is generally sold as a fine powder, owing to these crystals being 
easily pulverized. It is insoluble in absolute alcohol, but is soluble 
in ordinary water, and still more so in boiling water. In dilute alco- 
hol it is partly soluble. 

Fig. 10. 

□ f 

D 




A, Antimony d< pr< the heart-muscle : B, antimony depresses the peripheral portions of the 

m in the blood-vessels ; C, antimony depresses the vasomotor centre; i>, 
Dtre. 

Owing to Its chemical constitution tartar emetic should never be 
given with either acids or alkalies, and all drugs containing tannic 
acid arc also incompatible with it. owing to the fact that an insoluble 
tannate is rapidly formed, which is absorbed very slowly if at all. 
So complete is the insolubility of the compound so formed that tan- 
nic acid is the best antidote to the drug that we possess. 

Physiological Action. — Tartar emetic, when applied to mucous 
membranes, produces a burning sensation, and upon the skin ii may 



ANTIMONY. 83 

readily cause a large amount of irritation if the part be delicate. If 
kept in contact with a mucous membrane, very distinct inflammatory 
changes occur, and if it be applied to the skin for any length of time, 
redness, followed by acne of a pustular character, appears, which 
finally ends in ulceration and sloughing if the use of the drug is per- 
sisted in. Under these circumstances the vitality of the parts seems 
interfered with, and, as a result, healing takes place very slowly indeed. 

Nervous System. — Antimony is a depressant to the sensory side 
of the spinal cord and a paralyzant to all the spinal centres, motor 
and sensory, in poisonous dose. 

It is stated that when an animal is under its influence sensation to 
heat and acids is lost before the ordinary sense of touch is destroyed. 
The convulsions which sometimes ensue after poisonous doses in the 
lower animals are due to anaemia of the brain brought on by the cir- 
culatory depression. Ringer and Murrell have proved antimony to 
be a motor-nerve and muscle poison. 

Circulation. — The chief influence of antimony is exerted upon 
the circulation. In small doses it lowers the pulse-rate by a direct 
depression of the heart-muscle, and simultaneously decreases arterial 
tension by an action upon the peripheral portions of the vasomotor 
system in the walls of the blood-vessels, but the vasomotor influences 
may be in part centric, and this question must be considered as sub 
judice. The fall of arterial pressure is also due to failure of heart- 
force. With the lowering of the pulse-rate there is nearly always a 
corresponding decrease in cardiac power. 

When poisonous doses are employed, death ensues after great cir- 
culatory and respiratory depression, as will be seen below. The heart 
is found after death relaxed and flabby and utterly dead to all stimuli, 
although in one of the lower animals, such as the frog, if the dose has 
not been very excessive and digitalis is freely employed, the heart may 
be made to beat again. In man, it is hardly necessary to state, the dig- 
italis must be used early to render much service. The drug in poison- 
ous doses is thought to depress the peripheral ends of the vagus nerves. 

Respiration. — The drug has little or no effect upon respiration 
except when given in lethal doses. Under these circumstances death 
is produced in three ways, all of them acting together. Primarily, 
the respiratory centre in the medulla is depressed, and the governing 
nerves of breathing, the pneumogastrics, are also rendered inactive ; 
secondarily, the cardiac failure readily causes pulmonary congestion ; 
and, thirdly, the drug causes such an outpouring of liquid mucus into 
the bronchial tubes that the patient is drowned in his own secretions, 
which he is too weak to expel. 

Stomach and Intestines. — Antimony in toxic doses is a power- 
ful irritant to these portions of the body. In full medicinal amounts 
it acts as a slow but powerful emetic, producing much nausea. The 
vomiting is due to an action on the vomiting centre in the medulla 
and to a direct action on the stomach itself. The drug is, therefore, 
a centric and peripheral emetic. 

Very full doses produce watery purging, attended with some grip- 
ing and tenesmus. 



84 



DRUGS. 



Elimination. — Antimony escapes from the body in all the secre- 
tions, but largely by the bowels. The latter method of elimination seems 
chiefly to follow poisonous doses, and purging is an effort at elimination. 

Poisoning. — AVhen toxic doses of tartar emetic are taken, the pulse 
at first becomes slightly weaker and slower, the skin becomes moist and 
relaxed, a general sense of relaxation comes on, and simultaneously a 
sensation of severe nausea and gastric distress appears. 

Following this condition violent vomiting asserts itself. The 
ejected mass consists of the contents of the stomach — mucus, bile, and 
watery fluids, and perhaps blood. Purging appears almost as early 
as the vomiting, and consists first of the normal contents of the intes- 
tines, then mucus, then bile, and, very rarely, blood. These signs 

Fig. 11. 





A, Antimony stimulates the vomiting centre ; B, antimony irritates the gastric mucous 

membrane. 

may rapidly pass away and the characteristic peculiar "rice-water" 
stools 1 of antimonial poisoning appear. The general condition of 
the patient is now most serious. The face is pinched, livid, and cov- 
ered with a cold sweat, The pulse is rapid and shuttle-like — to and 
fro — or lost at the wrist; the arterial tension is almost nil. The res- 
pi rai ions are faint and fluttering, and so shallow as hardly to be seen 
or hoard. Cramps in the calves of the legs attack the patient, due 
to the abstraction of water from the tissues by the violent purging, 
and the temperature falls lower and lower as death approaches. The 
general condition is such that all the signs point to Asiatic cholera, 
and antimonial poisoning cannot be separated from this disease during 
an epidemic without a history of the case or a chemical analysis of 
the secretions, which ought always to be preserved. 2 

1 \ '• rice-water" Btool re one winch, on standing in a glass, separates into two lay- 
er-, the lower whin- and flocculent, the upper watery and almost clear. 

This i- :« good Opportunity to state that the secretions and excretions of a person 

dying of any poison Bhould he placed in a chemically-clean jar capable of being sealed 
tight The same rule of cleanliness applies to the jars holding organs at the post- 
mortem. The jars Bhould be ready, and no intermediate vessel used. They should 
be sealed :it once, and kept so until claimed by the authorities. 



ANTIMONY. 85 

The treatment of antimonial poisoning consists in the internal ad- 
ministration of large amounts of tannic acid, in the use of the stomach- 
pump, and in the maintenance of an absolutely prone position. The 
patient should vomit into towels and 'not raise the head from the 
ground; the head, indeed, should generally be placed lower than the 
heels. External heat, alcohol, and digitalis should be used thor- 
oughly, and opium should be employed hypodermically to allay pain 
and irritation, unless the respirations are too feeble. If the opium is 
greatly needed because of pain, and yet seems contraindicated because 
of depression, it should be accompanied by strychnine to stimulate the 
respiratory centre and overcome any depression produced by the opium. 

Fatty degeneration of all organs may occur after acute antimonial 
poisoning. 

Therapeutics. — Tartar emetic is employed for at least five separate 
purposes, the most usual of which is as a circulatory quieter and seda- 
tive. The indications for antimony as a circulatory depressant are not 
so generally recognized at present as they were at one time, on account 
of the introduction of other drugs. Suffice it to state that all states of 
sthenic inflammation with a bounding pulse, high fever, and symptoms 
showing the patient to be possessed of robust constitution permit of its 
use, while ail asthenic conditions most emphatically contraindicate 
its employment. In the treatment of colds, to break forming diseases, 
and to allay inflammation it is given in moderate dose. It is useful 
in sthenic bronchitis as an expectorant. Under these circumstances 
it may be given in emetic dose ; or, if emesis is not desirable, minute 
amounts given hourly are of value, such as -^ of a grain (0.001) 
every hour, or a teaspoonful of a solution of 1 grain (0.05) to \ a 
pint (250 cc.) every hour may be used. This is a particularly useful 
method in children, as the solution is tasteless and it does not pro- 
duce nausea and vomiting. 

In the acute catarrh of children, which affects the stomach and 
entire alimentary canal and is associated with little fever, the use of 
the drug is extremely valuable, and often aborts an attack when given 
in the same dose as just described. 

As an emetic antimony is slow but forcible. It ought not to be 
used in cases of poisoning by other drugs, owing to its slowness. 

Before the introduction of anaesthetics emetic doses were employed 
to relax the muscles in reducing dislocations and fractures. 

Tartar emetic is harmful if irritation of the stomach is present or 
if kidney changes are rapidly progressing. If one good-sized emetic 
dose is not sufficient to produce vomiting, it should not be repeated, 
but some other emetic or the stomach-pump be used, lest antimonial 
poisoning complicate the case. The emetic dose must be large enough 
to be effective, or none at all should be given. If this rule is dis- 
obeyed, systemic changes come on with undesirable severity in those 
cases where emesis fails to occur because of small doses. 

As a counter-irritant antimony is employed in the form of an oint- 
ment whenever a very slowly acting and prolonged counter-irritation 
is to be maintained, as on the back of the neck in epilepsy or similar 
chronic states, and in old enlargements of the joints. 



86 DRUGS. 

Antimony acts well as a diaphoretic, but its use is undesirable, 
owing to its disagreeable effects, such as nausea and intestinal dis- 
turbance, and because other, more pleasant, drugs act equally well. 

Administration. — The dose of tartar emetic when there is an 
excited circulation is -^ to -^ of a grain (0.003-0.006) every three 
hours until an effect is obtained. As an emetic the dose is J to 1 
grain (0.03-0.06). The wine of antimony {Vinum Antimonii, TJ. S. ; 
Vinum Antimoniale, B. P.) contains only 2 grains of tartar emetic to 
each ounce, and may be used in the dose of J to 1 drachm (2.0-4.0), 
or as an emetic in the dose of J to 1 ounce (2.0-30.0). The com- 
pound pill of antimony (Pilulce Antimonii .Composite?, TJ. S., or 
Plummer's pill) is used as an alterative, and contains sulphurated anti- 
mony J a grain (0.03), calomel \ a grain (0.03), guaiac 1 grain (0.06); 
the dose is one to three pills. 

The ointment of antimony {TJnguentum Antimonii Tartarati) is 
used externally as a counter-irritant spread on a rag or piece of lint. 
Antimonial powder (Pulvis Antimonialis, TJ. 8. and B. P.), or James's 
powder, contains oxide of antimony and phosphate of calcium, and is 
given occasionally as an antipyretic in the treatment of rheumatism 
and fever in the dose of 3 to 10 grains (0.15-0.65) ; it is best given 
in a pill. 

The compound syrup of squill (Syrupus Scillce Co?npositus, TJ. 8.), 
otherwise known as " Coxe's hive syrup," contains three-fourths of 
a grain (0.045) of tartar emetic to the ounce. The dose is 20 to 30 
minims (1.3-2.0) for an adult as a sedative, or from this amount to 1 
drachm (4.0) to a child as an emetic. 



ANTIPYRIN. 

Antipyrin is a derivative of coal-tar, its chemical name being 
phenyldimethylpyrazolon. It is also called Phenazonum (B. P.). 
It was discovered by Ludwig Knorr in 1884, and introduced into 
medicine by Filehne. Antipyrin is a white powder of a somewhat 
bitter taste, and is very soluble in water, less so in ether, alcohol, 
and chloroform. 

When antipyrin is given to a man in full medicinal amount, it 
causes a sensation of buzzing and tightness of the head not unlike that 
produced by quinine. The bodily temperature, if normal, is depressed 
a fraction of a degree, but no other symptoms are manifested. If the 
dose be quite large, some blueness of the lips and finger-nails appears, 
chilly sensations arc experienced, and finally a profuse sweat breaks 
()l " over the entire body, which is more severe if fever has previously 
existed. Large doses sometimes cause nausea and vomiting. 

Physiological Action. — NERVOUS SYSTEM. — When a large poisonous 
dose of antipyrin is given to one of the lower animals, relaxation, utter 
loss of reflex action, and total inability to move come on at once, and 
death ensues. Somewhal smaller doses produce exceedingly severe 
tetanic and epileptiform convulsions, but consciousness seems to be 
preserved. It has been proved that the chief cause of the convul- 



ANTIPYBIN, 87 

sion is an action of the drug on the brain. 1 Very large toxic closes, 
therefore, decrease reflex action, and smaller ones increase it, thouo-h 
medicinal amounts certainly lessen reflex activity to a notable degree. 
The cause of this failure of reflexes is depression of the sensory 
nerves and the receptive centres of the spinal cord. Medicinal 
amounts must, therefore, be regarded as very distinct nervous seda- 
tives, acting much more actively on the nerves of sensation than on 
those of motion. Injected beneath the skin or applied to a mucous 
membrane, antipyrin is a powerful local anaesthetic, the anaesthesia 
lasting often for several days. 

Circulation. — The studies of a very large number of pharma- 
cologists prove most conclusively that antipyrin has no effect on the 
circulation of the lower animals in moderate doses unless these be so - 
frequently repeated that cumulative effects ensue. Many reliable 
clinical observers have asserted that the drug depresses the circula- 
tion in man in some cases, and antipyrin is certainly not a cardiac 
stimulant. The writer is confident, however, that antipyrin is not so 
distinctly a cardiac depressant as some think. Large, poisonous doses 
lower blood-pressure, unless convulsions are present, when the pressure 
is raised. The action of the drug on the circulation is nevertheless a 
very unimportant part of its power, and in most cases is not to be 
considered in the treatment of disease unless the circulation is feeble. 
In many of the cases where vascular depression and collapse have 
followed its use it has been employed in excessive amounts, or the 
fall in bodily temperature has caused the untoward symptoms. (See 
Fever and its Treatment.) 

Blood. — No spectroscopic changes in the blood follow the use of 
medicinal doses of antipyrin in the ordinary individual, but in poi- 
sonous amounts it produces methsemoglobin. If the doses be toxic 
or idiosyncrasy exists, cyanosis may come on. That the blood is not 
destroyed by small amounts is proved by the absence of hsematin in 
the urine of persons taking the drug. The corpuscles suffer no 
changes except in very pronounced poisoning, when they are said to 
become crenated and shrivelled. 

Respiration. — When antipyrin is given in lethal doses, death 
results from failure of the respiratory centre. Ordinary doses have 
no effect on this function, but large ones make the breathing more 
rapid. 

Temperature. — In normal men and animals antipyrin in medi- 
cinal dose may be considered as without effect so far as bodily tempera- 
ture is concerned. In fevered animals it has been found to lower 
temperature by decreasing heat-production and increasing heat-dissi- 
pation. That it does not do this by an action on the blood seems 
proved by the fact that the blood is not affected by medicinal amounts. 
The sweating does not cause the fall, since it takes place when no 
sweating occurs. It may, therefore, be considered that the drug 
directly affects the nervous heat-mechanism of the body. 

Kidneys, Tissue-waste, and Urine. — A large number of studies 

1 See author's Boylston Prize Essay of Harvard University on Antipyretics, Phil- 
adelphia, 1891. 



88 DRUGS. 

made upon man and the lower animals by competent investigators 
have brought about very considerable advances in our knowledge of 
the influence of antipyrin upon tissue-waste. It is useless to burden 
this volume with a discussion of their methods and results, which may 
be found in the author's Essay on Antipyretics. Suffice it to say that, 
while all observers are not agreed as to the effects produced, the deduc- 
tions apparently to be drawn are that the drug diminishes the quan- 
tirv of the urine excreted, and also decreases the elimination of the 
results of nitrogenous tissue-metamorphosis — or, in other words, is a 
conservator of the tissues of the body. 

ELIMINATION. — The elimination of antipyrin goes on very rapidly 
indeed, and begins almost at once after its ingestion. Maragliano and 
Reihlen state that it appears in the urine in three hours after it is 
taken, so that at the fourth hour elimination is at its height, although 
it continues to be eliminated for twenty-four or perhaps thirty-six 
hours. According to Pavlinow, part of the antipyrin ingested is 
eliminated by the salivary glands. 

Poisoning. — The treatment of poisoning by antipyrin consists in 
the administration of stimulants, the maintenance of bodily heat, the 
use of atropine to restore the tone of the vascular system, and, if 
cyanosis is alarming, the employment of oxygen inhalations. 

Antiseptic Power. — Antipyrin exerts a very distinct antiseptic 
action in small amounts, delays all forms of fermentation, and destroys 
germs when it is present in large quantity. 

Therapeutics. — Antipyrin is employed in medicine for two great 
purposes — namely, for the reduction of fever and the relief of pain — 
but its employment as an antipyretic is now entirely surpassed by its 
use as an analgesic. 

As an antipyretic, antipyrin should be given in a few full doses 
rather than frequent small ones, as a general rule, since if the fever 

;' any severity the latter method of administering it will have no 
effect, and the constant dosing will produce a gradual saturation of the 
system without causing a fall of temperature. On the other hand, too 
large doses may depress the temperature to a point below normal and 
induce collapse. In the article on Fevers (Part IV.) the conditions 
are indicated in which the drug is best employed, these being the 
sthenic fevers as a rule, or instances where excessive outbursts of fever 
necessitate prompt reduction of temperature. In excessively high tem- 
/>> rature in pneumonia it may prove of great value, and in scarlet fever 
and smallpox antipyrin is of service in some instances, although in 
pneumonia, as a rule, the condition of the patient indicates the use of 
cold t<» the chest as a local measure for the reduction of congestion or 
cold sponging to relieve fever. (See Pneumonia.) The use of the 
cold applications is always to he preferred to antipyrin in the reduc- 
tion of fever, since they are safer, more reliable, and do not strain the 
kidneys, reduce the blood, or depress the heart in feeble patients. (See 
Cold and Fever.) When cold water cannot be used, then antipyrin 
may he employed. In phthisis antipyrin generally increases the sweat- 
in;/, produces oppression, and either tails to act 'as an antipyretic or 
produces collapse by exercising too great an effect. In sunstroke it 



ANTIPYRIN. 89 

frequently fails to influence the temperature, and ought not to be 
used. 

Be the fever what it may, provided it be associated with any dis- 
eased process, antipyrin is absolutely useless so far as any influence 
over the course of the disease itself is concerned. It is a remedy to 
be used in the treatment of the symptom, not for the removal of the 
cause of the fever. 

As an analgesic antipyrin is the peer of opium. Although .the 
latter drug will relieve all forms of pain if it be pushed, it possesses 
many disadvantages not found in antipyrin. In deep-seated pains due 
to disease of the organs of the body, in inflammations and similar dis- 
turbances, antipyrin is useless. In neuralgic affections of all kinds it 
finds its sphere, particularly if the disorder be rheumatic, gouty, or due 
to nervous depression from nervous exhaustion or disease. Under the 
latter circumstances it is best combined with caffeine and a little bromide 
of potassium. (See Neuralgia.) In rheumatism it will give relief in a 
fairly large number of cases, not only relieving the pain and fever if 
they be present, but also actually modifying the disease. It seems, 
however, to increase sweating in acute articular rheumatism. In gout 
it is stated to have a specific curative effect upon the disease over and 
above the relief of the pain 7 but this is doubtful. Its use in dysmenor- 
rhoea has been recommended, but its beneficial influence in such cases 
is doubtful. At one time it was thought that its use would relieve 
the pains of labor entirely, but this has, unfortunately, proved untrue. 
It may, however, be tried, when the suffering is very severe, in the 
dose of 15 grains (1.0). In the severe lancinating or darting pains 
of locomotor ataxia, and in the laryngeal and gastric crises compli- 
cating this disease, antipyrin is an invaluable and reliable remedy 
Curiously enough, it seems to subdue acute attacks of pain in posterior 
sclerosis, but fails to control the slighter pains and muscular twitchings 
sometimes seen in this disease and in myelitis.. 

Some clinicians have used antipyrin with asserted great success in 
diabetes mellitus. In such instances the disease often depends on a 
gouty diathesis, and can be well relieved by salicylates. Antipyrin 
may be used hypodermically in the region of a hypersensitive nerve as 
a local anaesthetic. The anaesthesia produced by it lasts for several 
days, but the pain immediately after the injection is severe. 

Antipyrin is a very useful remedy in epilepsy. (See Epilepsy.) 

In tuhooping cough antipyrin has more frequently given relief in the 
writer's experience than any other remedy. It should be given to a 
child of five years in the dose of 2 grains (0.1) every four or five hours, 
the patient being watched for cyanosis and the drug stopped as soon as 
this symptom appears. Antipyrin generally decreases the frequency 
rather than the severity of the attacks of cough. 

In malarial diseases antipyrin certainly exercises no antiperiodic 
influence, although it controls the febrile paroxysms to a great extent. 
Yet, while this is the opinion of the majority of those who have used 
it, it cannot be said that every observer has reached similar conclu- 
sions. Potter reports cases where the results obtained from its use were 
most satisfactory, particularly in the intermittent form of malarial poison- 



90 DRUGS. 

ing. One cannot help thinking that frequently where antipyrin has 
been reported as acting as an antiperiodic it has simply lowered the 
fever, and so seemed to affect the disease. 

In acute coryza the temporary relief produced by applying cocaine 
to the engorged Schneiderian membrane may be prolonged indefinitely 
by the use of a spray of antipyrin in the strength of 4 per cent. This 
produces a smarting sensation, which speedily passes away. The same 
treatment is of value in inflammations of the larynx and pharynx. 
Should cocaine solutions not precede the antipyrin, the primary irri- 
tant effects persist unless the strength of the solution of antipyrin is 
reduced to 1 or 2 per cent. It is always better to precede its use by 
cocaine. 

Locally applied, antipyrin possesses very distinct haemostatic prop- 
erties* and for this purpose may be used in a 4 per cent, solution, either 
in liquid or in a spray. Under these circumstances it seems to act not 
by producing clots, which are disadvantageous from the standpoint of 
antisepsis, but by constringing the bleeding vessels. This haemostatic 
property is very materially increased if a solution of tannic acid is 
added to it, when it forms a glutinous precipitate which controls the 
hemorrhage. The precipitate is best applied by means of a swab. 

Antipyrin may be given with cocaine in suppository to check bleed- 
ing from hemorrhoids and relieve rectal pain. The cocaine must be 
used to prevent the antipyrin from causing pain when the suppository 
is first introduced. 

Untoward Effects. — Aside from the results of poisonous doses, a cer- 
tain number of cases taking this drug present slight cyanosis or duski- 
ness of the hands and of the face about the nose and lips; the fingers 
may be cold and clammy, and the feet are often very cold ; sweating is 
a very common symptom of the untoward influence of antipyrin, and 
pricking or tingling of the skin is not uncommonly seen. By far the 
largest number of these cases, however, suffer from disorders associ- 
ated with the skin, and erythematous patches may be seen every- 
where, more particularly on the hands and feet and about the face, 
alius, and ehest. Occasionally pemphigus-like spots appear, and 
often large bullae have been noted as present. Elsewhere are pub- 
lished the statisties, collected from medical literature, of 121 cases 
of untoward effect- exercised by antipyrin. 1 An analysis of these 
sh«.\s>. that females were; much more frequently affected than males, 
and that the most susceptible age was decidedly that of full adult life 
— namely, from thirty to forty years in both sexes. The dose caus- 
ing these effects was most commonly a moderate one — from 10 to 15 
grains (0.65-1.0), or even from 4 to 10 grains (0.2-0.65). This fact 
holds good with regard to both sexes. The time of onset of the 
Bymptoms varied somewhat, according to whether the drug was given 
in one excessive d'^v <>v in frequently-repeated medicinal doses. In 
many instances the appearance of the symptoms was sudden rather 
than gradual. A- a rule, the duration of the symptoms did not 
exceed one to three hours, three days being the longest time men- 
tioned. It is interesting to note, however, that of all these cases only 
3ee author's Boylston Prize Eaeay <>n Antipyretics, Philadelphia, 1891. 



ANTITOXIN— APIOL. 91 

six proved fatal, and in these' there was ample cause for death aside 
from any effect of the drug. We can rest assured, therefore, in ordi- 
nary cases of disease that patients exhibiting untoward effects of anti- 
pyrin are not in any acute danger, although the symptoms may be 
temporarily most alarming. Typhoid fever seems, according to the 
statistics collected by the writer, to be the disease in which this unex- 
pected influence manifests itself most frequently, but this may be due 
to the fact that it is so common a malady and is so frequently treated 
by means of antipyretics. Brunton is responsible for the statement 
that antipyrin is particularly prone to produce collapse in menstru- 
ating women. Falck has collected a large number of cases of antipy- 
rinism, and quotes Pusinelli as having seen vomiting often follow the 
use of this drug. 

Antipyrin very distinctly increases susceptibility of patients to tak- 
ing cold, and ought not to be employed by those who are forced to go 
out of doors in cold weather. 

Administration. — Owing to the solubility of antipyrin, it is most 
readily given in a little water in a wineglass or spoon. If its slight 
taste is disliked, it may be dissolved in any one of the aromatic waters 
or in syrup of bitter orange-peel or some similar vehicle. Most per- 
sons prefer to take it with water. The amount which may be given at 
a dose is 5 to 20 grains (0.3-1.3), but 3 to 5 grains (0.3) is the best 
dose in most cases, at least until it is seen how well it is borne. 

Incompatibles. — When added to sweet spirit of nitre, antipyrin in 
the course of a few moments produces a blue, changing to a dark- 
green, color, owing to the formation of iso-nitroso-antipyrin, which 
is not poisonous, but when in the form of a dry powder is readily 
oxidized on exposure to slight heat. If this color is not formed, the 
spirit of nitre lacks its nitrous ether, and is worthless, so that we have 
not only another incompatibility to remember, but a new means of 
testing the therapeutic value of all samples of sweet spirit of nitre 
which may be dispensed by druggists. Antipyrin is also incompatible 
with the salts of iron, calomel, corrosive sublimate, and carbolic acid. 
With salicylate of sodium it forms a pasty mass ; with chloral an oily 
liquid. Beta-naphtol and tannic acid are also incompatible with it. 
Tannic acid and non-alcoholic solutions of tannic acid form an in- 
soluble precipitate with antipyrin, as does also the tincture of iodine. 



ANTITOXIN. 
(See Part III.) 

APIOL. 

Apiol itself is a camphoraceous body, derived from common parsley or 
Petroselinum.. As its melting-point is very low, it cannot be kept in 
solid form, and is always dispensed in 75 per cent, solution. So far as 
is known to the author, no careful study of its physiological action has 



92 DRUGS. 

ever been made, but two French observers, Joret and Homolle, state 
that in overdose it causes ringing in the ears, intoxication, and severe 
frontal headache. 

Therapeutics. — Originally introduced to combat malarial fevers, 
because of a fancied resemblance in its toxic action to quinine, apiol 
has at last found its true level as a remedy in amenorrhea, given in 
the dose of 2 to 8 minims (0.1-0.5) three times a day for a week 
before the proper date for menstruation. It should be given, if pos- 
sible, in capsules, owing to its bad taste. It is said not to possess 
any abortive influences, although it is often taken with this object in 
view. 

Apiol is imported from France in capsules containing a little less 
than 3 minims (0.15), and is also put up in soft elastic capsules in this 
country. 

APOCYNUM. 

Apocynum Cannabinum should not be confused with Apocynum 
Androsimcefolium, which has few of its properties, but which is 
often employed by mistake for the real drug. When good effects do 
not follow the use of the drug another sample should be tried. The 
remedy in overdose is capable of causing vomiting and purging through 
gastro-intestinal irritation, but in medicinal dose rarely does so. It is 
employed in medicine for the relief of cardiac and renal dropsy of the 
subacute or chronic type, and is best given in the form of the tincture 
or fluid extract in the dose of 5 to 20 minims (0.30-1.5) of the former 
or 1 to 5 minims (0.01-0.30) of the latter. Under its influence profuse 
diuresis occurs, and the fluid is removed so rapidly that the drug has 
been called the " vegetable trocar." 

Physiological studies show that the action of the drug on the heart 
is similar to that of digitalis, as it slows the pulse and raises blood- 
pressure. 



APOMORPHINE. 

Apomorphine is an artificial alkaloid obtained by the action of 
hydrochloric acid upon morphine in a sealed tube to which is applied 
a high heat. It is a whitish or gray powder, made up of minute crys- 
tals, which rapidly undergo decomposition when exposed to the air. 
The drug should be kept in dark bottles well stoppered. A very 
important point to remember is that solutions rapidly decompose, and, 
if employed, may produce poisonous symptoms. The drug ought to be 
freshly dissolved each time it is used. If the salt imparts an emerald- 
green color to 1 ( ) ( ) parts of water when shaken a few times, it should be 
rejected, unless it is found that the water contains small amounts of 
ammonia, which is supposed to be active in causing such a change. 

According to Boyer and Guinard, there are two kinds of apomor- 
phine sold. Each has a physiological effect different from the other. 
The crystalline form, which is the one always to be employed, causes, in 
overdose, irritation, spasms, trismus, vertigo, and hyperesthesia ; while 



APOMORPHINE. 



93 



the amorphous (never to be used) causes collapse, hypothermia, general 
weakness, feebleness of the heart and respiration, and anaesthesia. 

Physiological Action. — One of the best studies of this drug is that 
of Reichert, who found that in poisonous doses it produces convulsions, 
and finally paralysis, both of which are chiefly spinal in origin. 

Nervous System. — On the nervous centres in the brain apomor- 
phine acts as a stimulant, but the convulsions produced by poisonous 
doses are probably spinal. The motor and sensory nerves are paralyzed 
by poisonous doses, and even the muscles become poisoned and incap- 
able of contraction. Medicinal doses have no effect. 

Circulation.— Apomorphine increases the rapidity and force of 
the pulse and raises arterial pressure, when given in moderate 
amounts, by stimulation of the accelerator nerves and the vasomotor 
centre. In large doses it acts as a circulatory depressant. 

Fig. 12. 




A, Apomorphine stimulates vomiting centre in the medulla. 



Respiration. — After ordinary amounts no changes in respiration 
occur, but after poisonous doses the breathing becomes rapid and 
irregular. 

Vomiting. — Vomiting is produced by a direct action of the drug 
upon the vomiting centre in the medulla, and not by an action on the 
stomach. Apomorphine is, therefore, a typical centric emetic. 

Therapeutics. — Apomorphine is useful in nearly all cases where an 
emetic may be employed. In poisoning from other drugs, particu- 
larly depressants and narcotics, we have little knowledge of its safety, 
but, unless the stupor or circulatory change is very profound, the 
drug may be used with care. In subacute and chronic catarrh of the 
stomach and air-passages it may be useful in getting rid of the mucus 
by emesis, and in non-emetic dose it is a useful remedy in acute 
bronchitis when it is necessary to quiet irritation and relieve excessive 
cough, or when the secretion which has been poured out is very scanty. 
Quite recently small non-emetic doses of -fa grain (0.002) have been 



94 DRUGS. 

used with asserted success in producing nervous quiet in alcoholic 
excitement and delirium tremens. 

Untoward Effects. — Apomorphine rarely causes disagreeable effects, 
but there are cases on record in which it has produced serious symp- 
toms, even when given in ordinary doses. These symptoms have con- 
sisted in depression and collapse. One-fifteenth of a grain has caused 
death in a woman who had bronchitis, but was otherwise healthy. 
Probably in these cases the amorphous form already named was 
used. 

Administration. — The drug when used as an emetic should always 
be given hypodermically and the solution be freshly prepared. The 
emetic dose is about ^ of a grain (0.006), but as much as -J- (0.01) 
may be used in strong patients. The expectorant dose is -^ to -^ 
of a grain (0.0015-0.003) by the mouth. No nausea is usually felt. 
The drug nearly always acts badly in children, and it is better not 
to use it in this class of patients. The salt used is Apomorphinat 
JTydrochloras, U. S., and Apomorphinw Hydrochloridum, B. P. An 
injection (Injectio Apomorphinm Hypodermica) — 1 grain (0.05) dis- 
solved in 100 minims (6.0) of camphor-water — is official in the B. P. 



ARISTOL. 
(See Thymol Iodide.) 

ARNICA. 

Arnica is a medicine derived from Arnica montana, a native plant 
of the Western United States and Europe. It holds a very high 
position in domestic medicine as a local and internal remedy in sprains 
and braises and in the treatment of passive hemorrhages, amenor- 
rhea, and similar states. Two parts of the plant are official — the 
arnica-flowers (Arnicce F lores, U. S.) and the root (Arnicas Radix, 
/'. S., Arnicoe Rhizoma, B. P.). 

Physiological Action. — When arnica is applied to a delicate skin, 
it produces burning and irritation, and even extensive skin lesions. 
According to the studies of the author, it slows the pulse, raises the 
blood-pressure slightly, and stimulates the vagus nerves. Toxic doses 
produce a rapid pulse from paralysis of these nerves. 

Administration. — Arnica is rarely given internally. If it is so 
used, the dose of the tincture (Tinctura Arnica? Radicis, U. S.) is 
15 to o ( > minims (1.0—2.0), and the same amount of the tincture of the 
flowers [Tinctura Arnicce Florum, U. S.) may be employed. The 
solid ( E.itrdrtioii Amieir /Indicts, U. S.) and the fluid extract of the 
root ( Extractum . 1 rnicce Radicis Fluidum, U. 8.) are also official. The 
dose of these preparations is 3 to 5 grains (0.2-0.3) and 5 to 10 minims 
(0.3 -0.65) respectively. The plaster (Emplastrum Arniew, U. S.) is 
v< ty useful for external applications. 

The tincture of arnica is the preparation usually applied to sprains 



ARSENIC. 95 

and bruises, and the alcohol contained in this preparation accomplishes 
a large part of the good achieved. 

The only British preparation is the tincture (Tinctura Arnicce), 
which is given in the dose of 30 minims to 1 drachm (2.0-4.0). 

ARSENIC. 

Arsenic (Arsenicum) itself is never employed in medicine, but it 
is used in the form of arsenous acid or the arsenates of sodium, 
potassium, or copper. 

Arsenous acid (Acidum Arsenosum, U. S. ; Acidum Arseniosum, 
B. P.) is derived from arsenic-bearing ores by roasting them in a 
reverberatory furnace, when it rises in the form of a vapor which 
adheres to the walls of the furnace, requiring a second subli- 
mation, owing to the first deposit being quite impure. It is soluble 
in water, is without odor, and when heated gives off the smell of 
garlic. 

Physiological Action. — The changes produced in man by poisonous 
doses will be found considered under the heading of Poisoning. 

Applied to the normal skin, arsenous acid produces no change of 
any moment whatever, but if the surface be broken or a wound or 
sore exist, its action is very powerful, and it destroys the tissues to a 
considerable extent. For this reason it has been employed as a caustic 
by " quacks " and to some extent by regular physicians, the latter 
using it to remove warts, condylomata, and similar growths, while the 
former have employed it chiefly as a " cancer cure," asserting that it 
would take the disease "out by the roots.'' 

Absorption. — Arsenic is slowly absorbed. 

Nervous System. — When small amounts of arsenic are given to 
animals, particularly those of the lower types as represented by the 
frog, reflex action is lost long before, or more rarely at the same time, 
that voluntary movement is put aside, and, finally, all sensation to 
pain produced by heat and pinching totally ceases. It is therefore 
quite evident that the sensory nervous apparatus is affected, and 
experiments have proved that the sensory tract of the spinal cord is 
at fault. Ultimately, however, the motor system also fails and com- 
plete motor palsy ensues. Arsenic in poisonous amount acts as a 
depressant poison to all protoplasm with which it may come in con- 
tact (Ringer and Murrell). In medicinal amounts the drug acts as a 
nervous excitant and as a stimulant to the trophic nervous apparatus. 

Circulation. — In moderate amounts arsenic has little or no in- 
fluence upon the circulation. Large doses cause marked decrease in 
the force and frequency of the- pulse, accompanied by a decided fall in 
arterial pressure, and in these amounts it is to be regarded as a distinct 
cardiac depressant which depresses all the heart's component parts, 
such as the ganglia, muscle, and nerves. The fall of the arterial pres- 
sure is due to vasomotor depression with relaxation of the general 
blood-vessels, more especially those of the abdominal cavity. Accord- 
ing to Lesser, small doses cause it to act as a cardiac stimulant, 
increasing the pulse-rate. Arsenic is absorbed by the blood-vessels. 



96 DRUGS. 

Respiration. — In small amounts arsenic very distinctly stimulates 
the respiratory centre, and Lesser asserts that small doses stimulate 
the peripheral ends of the vagi in the lungs, but that in toxic quan- 
tities arsenic acts as a powerful respiratory depressant. 

ELIMINATION. — Arsenic escapes from the body chiefly by the kid- 
nevs, skin, and bowels, but usually does not appear for from fourteen to 
sixty hours after its ingestion in medicinal amount. In poisoning the 
purging which is produced carries off much of the drug, but after me- 
dicinal amounts some traces of it may be found in the saliva and in the 
milk of nursing women. The writer has seen colic produced in infants 
taking milk at the breasts of women who were receiving large doses of 
Fowler's solution. 

Tissue-waste. — According to Chittenden and Cummins, arsenic 
in medicinal amount distinctly decreases tissue-changes. Large doses, 
however, greatly increase nitrogenous metamorphosis. 

Therapeutics. — Arsenic is used in chorea, in which it is almost a 
specific, acting in an unknown manner. Small doses should be given 
at first, and later on the dose should be increased rapidly, as patients 
soon get accustomed to the drug. Cases are on record, however, in 
which the too rapid increase of the drug in medicinal doses has 
developed arsenical neuritis. As a tonic combined w T ith iron it is 
invaluable in malarial ancemia and cachexia. In atony of the mucous 
membrane of the stomach and intestines it is exceedingly useful, and 
in ordinary anaemia and debility, combined with a simple bitter tonic, 
it is invaluable. Arsenic offers the best chance of saving cases of per- 
nicious a mania. In leucocyihavmia and pseudo-leukaemia arsenic is 
again the remedy, and it must be constantly given up to the point of 
intolerance to be of value. In the latter disease good results have fol- 
lowed its use when intraglandular and intrasplenic injections of 4 minims 
(0.2) of Fowler's solution were used, and any case of severe anaemia 
where the stomach is disordered may be treated by giving by the rec- 
tum in starch- water three times the ordinary dose or by its use hypoder- 
mically in the proportion of 4 parts water to 1 of Fowler's solution. 
Perhaps a better way of giving arsenic hypodermically, because it is 
less irritating, is by the use of cacodylate of sodium. A substitute con- 
taining 0.25-0.45 (4 to 7 grains) of cacodylate of sodium, in 200 cc. 
(6 ounces) of water, may be used and given hypodermically in the dose 
of 4 cc. 1 1 drachm) every other day. (See Sodium Cacodylate.) 

I ii malaria arsenic acts as a prophylactic, as a cure, and as an aid to 
convalescence. When the attacks of intermittent fever are far apart 
arsenic is useful as an antiperiodic, quinine being withheld for use dur- 
ing the at tuck itself. Arsenic is of value, too, for the improvement of de- 
praved mucous membranes of the respiratory tract, particularly in those 
persons who have not true tuberculosis, but phthisical tendencies; that 
is. individuals who continually have colds in the head, chest, or 
elsew here. 

No drug is so universally abused as is arsenic in the treatment of 
skin disease: it should never be employed in "wet" skin diseases; 
thai is, those associated with much proliferation of new cells and the 



ARSENIC. 97 

exudation of serum and other liquids. Its field of usefulness is in 
the dry, scaly skin affections. 

Where the skin is aifected in its lower layers arsenic is useless, and 
should be used only where the epiderni is diseased (Duhring). 

In psoriasis arsenic at first makes the skin more red and seemingly 
worse, but this passes off and the disease gets well. This is important 
to remember, as otherwise the drug may be stopped just when doing 
good. Pemphigus, lichen, and lepra all yield to its influence in most 
instances. 

In the treatment of diabetes and pruritus vulvas the drug is said to 
be of value when given internally. In gouty diabetes the use of the 
carbonate of lithium and the arsenate of sodium is often of great 
service. 

In asthma, particularly where the mucous membranes are at 
fault, arsenic is one of the best remedies that we have, either given 
internally or smoked in arsenic cigarettes, which are to be made as 
follows : l 

R. — Belladonna foliorum . . gr. xcvj. 

Hyoscyam. foliorum gr. xlv. 

Stramonii foliorum gr. xlv. 

Extract, opii gr. iv. 

Tabaci gr. lxxx. 

Aquae Oj— M. 

Ft. sol. et adde. 

Potassii nitratis gr. clx. 

Potassii arsenitis gr. cccxx. — M. 

Bibulous paper is to be wetted with this compound, and after drying is to be rolled up 
and smoked as a cigarette. 

A more simple procedure is to wet bibulous paper in a solu- 
tion of arsenite of potassium of the strength of 15 grains to the 
ounce. 

In chronic rheumatism arsenic is very valuable in certain cases, but 
often fails to be of service. In coryza, in cancrum oris, severe sore 
throat, and chronic nasal catarrh it is to be employed internally, and 
in some cases of hay fever undoubtedly affords relief. The use of 
arsenic in all stages of phthisis often gives the most surprising results. 
In gastric cancer and ulcer, given in small amounts frequently repeated, 
arsenic will often do good by relieving the pain and checking the 
vomiting. It may be tried in the vomiting of pregnancy with some 
chance of success, and is often of value in the vomiting of hand-fed 
babies who are suffering from chronic gastric catarrh. It is also useful 
in the morning vomiting of drunkards. In atonic dyspepsia associated 
with chronic diarrhoea and with evidences of dysentery arsenic is of 
service, and in small amounts it is very valuable in frequently repeated 
doses (-j-J-0 of a grain (0.0006) every hour) in all forms of serous 
diarrhoea. 

For gastric atony or torpidity the following prescription is use- 
ful, but if irritation of the stomach is present it should not be 
employed : 

1 Philadelphia Hospital Pharmacopoeia. 

7 



98 DRUGS. 

R— Liq. potassii arsenitis f^ss (2.0). 

Tr. liucis vomica? f^j (4.0). 

Aqua? q. s. adi^iij (96.0).— M. 

S. — Teaspoonful (4.0 | t. d. in water after meals. 

Ill old persons whose feet become sivollen and hot after prolonged 
standing, and who have shortness of breath on exertion, arsenic does 
cood, particularly if the cause be cardiac feebleness, when it increases 
the efficacy of digitalis or strychnine so greatly as to be generally indi- 
cated when these drugs are given. 

Locally applied to warts and other growths of the skin for several 
days in the form of Liquor Arsenicalis (B. P.) or Liquor Acidi Ar~ 
%i ( U. S.) or of Fowler's solution, it causes the growth to drop off 
or to become very much loosened. Where the growth is very hard and 
horny, its surface should be softened by the application of liquor po- 
tassa before the arsenical liquor is applied. The same treatment may be 
used for corns, and salicylic acid can be employed in a similar manner, 
but is not so efficient. Where large growths with wide surfaces are to 
be attacked the physician must use arsenic most boldly or not at all. 
The danger of absorption is only escaped when the drug is used so 
generously as to destroy the tissues before they can carry on any 
absorption of the poison. A very large area should not be treated at 
one time. Marsden recommended the use of 1 ounce (30.0) each of 
arsenous acid and powdered gum acacia to 5 drachms (20.0) of water 
a- an application to cpitheliomatous growths. A less painful applica- 
tion, because of the anesthesia caused by orthoform, is as follows : 

R.— Orthoform 3J (4.0). 

Acid, arsenosi 3j (4.0). 

Alcohol f%v (155.0). 

Aqua? destillat f§v (155.0). 

And still another is as follows : 

R. — Acid, arsenosi gr. lxxv (5.0). 

Pulv. acacia? gr. lxxv (5.0). 

Cocain. hydrochlorat gr. xxx (2.0). 

Glycerin. \\ xxx (2.0). 

Aquae destillat q. s. 

M. It. paste. 
S. — Apply locally. 

The Marsden paste should be applied to the depth of about one- 

quarterof an inch, overlapping the edges of the sore, and then covered 

with patent lint. The application is continued from twenty-four to 

forty-eight hours, and then a poultice is applied and the slough re- 

ed after from five to ten da vs. 

Administration. — Children generally bear more arsenic than adults, 
proportionately, and Ringer states that boys bear less than girls. The 
drug should generally be administered after meals, as it is apt to irritate 
tin- stomach if given when tins viscus is empty. Wlienever a patient 

given arsenic, In- should be cautioned to watch for any puffiness 
about tin- eyes, particularly in the morning on arising, and for slight 
laxity of the bowels and griping. These are signs that the drug 
Bhould be -tupped for a day or more. The swelling under the eyes 



ARSENIC. 99 

may spread if the use of the drug is persisted in, and finally amount 
to general anasarca. This is due at first to a cellulitis, and afterward 
to a true effusion. (See Untoward Effects.) 

The official preparations are : arsenous acid (Acidum Arsenosum, 
U. S.. Acidum Arseniosum, B. P.), the dose of which is -j^ to ■£$ 
of a grain (0.0015-0.003); the solution of the arsenite of potassium 
(Liquor Pot as sii Arsenitis, U. S. ; Liquor Arsenicalis, B. P.) or Fow- 
ler's solution, the dose of which at first is from 1 to 5 minims (0.05- 
0.3) in water; the solution of arsenate of sodium {Liquor Sodii 
Arsenatis, U. S. and B. P.), or Pearson's solution, the dose of which 
is 1 to 5 minims (0.05-0.3), and the solution of arsenous acid (Liquor 
Acidi Arsenosi, U. S.), the dose r of which is 1 to 5 minims (0.05-0.3). 
This is more irritating to the stomach than the other preparations. 
The iodide of arsenic enters into Donovan's solution (Liquor Arsenii 
et Hydrargyri lodidi, IT. S. and B. P.), the dose of which is 2 to 10 
minims (0.1-0.65), well diluted. Iodide of arsenic (Arsenii Lodidam, 
IT. S. and B. P.) is given in ^V grain (0.003) doses, and arsenate of 
sodium (Sodii Arsenas, IT. S. and B. P.) in the dose of g 1 -^ to ^ of 
a grain (0.002-0.006). Liquor Arsenici Hydrochloricus is also official 
in the B. P. 

Untoward Effects. — If arsenic is taken in full dose by a sus- 
ceptible person, it may cause a marked dermatitis, with a sensation of 
severe burning in the skin. Pustulations may occur, and Falck asserts 
that an erysipelatous state may arise. Almost any form of skin lesion 
may follow its use internally or externally, but nearly all show irrita- 
tion of the true skin. Even a scarlatiniform eruption followed by des- 
quamations may ensue. In other cases the mucous membranes become 
inflamed and coryza and disorders may develop. (See Administration.) 

Acute Poisoning. — Arsenic is a gastro-intestinal irritant, producing, 
when taken in poisonous dose, violent vomiting and purging, with 
great pain in the oesophagus, stomach, and entire belly. The passages 
finally become watery and resemble "rice-water" stools, but are to be 
separated from those of cholera and antimonial poisoning by the pres- 
ence of blood and, if necessary, by chemical analysis. The mucous 
membrane is stripped off the bowel and appears in shreds in the pas- 
sages. Very commonly about the third day, if the patient survives so 
long, an intermission in the attack appears, which will be followed by 
a return of all the symptoms, so that the physician must not give a 
favorable prognosis. In this symptom (remission) the course of arsen- 
ical poisoning resembles phosphorus-poisoning and yellow fever. Death 
generally occurs about the fourth or sixth day, and on or about the 
third day a peculiar skin eruption sometimes appears which may be of 
any character. In rare cases sudden pain, collapse, and death may 
take place after the ingestion cf the poison. Widespread multiple 
neuritis may be brought on. A typical change always present in acute 
poisoning when the patient lives for any length of time is fatty degen- 
eration of all the tissues. 

Treatment of Acute Poisoning. — In addition to washing out 
the stomach by the stomach-pump, applying external heat and stim- 
ulants, the proper antidotes should be at once employed, and the only 

L.ofC. 



100 DRUGS. 

ones of anv value are the freshly-precipitated hydrated sesquioxide of 
iron and magnesia. (See below.) The first is to be prepared by the 
precipitation of iron from one of its fluid preparations by the use of an 
alkali. Ammonia added to the tincture of the chloride of iron is effi- 
cacious, but the precipitate has to be repeatedly washed to rid it of an 
excess of this irritant. Magnesia is a better precipitant, because it not 
only precipitates the iron, but is an antidote itself. Monsel's solution 
and the so-called dialyzed iron may be employed in place of the tinc- 
ture, but Monsel's salt is too irritating, and dialyzed iron is so readily 
precipitated that it needs no alkali, but may be given pure. Magnesia 
is a useful antidote when used alone. 

Under the name Ferri Oxiclum Hydratum cum Magnesia the U. S. 
P. recognizes an antidote for arsenic ; this is often called the " anti- 
dot urn arsenici." The U. S. P. directs that this antidote should be 
kept on hand for immediate use in the following manner : Mix 13J 
fluidrachms (50.0) of the official solution of the tersulphate of iron 
{Liquor Ferri Tersulphatis) with 4J- ounces (100.0) of water, and keep 
the mixture in a well-stoppered bottle. Rub 150 grains (10.0) of 
magnesia with a little water to a smooth and thin mixture ; transfer 
it to a bottle capable of holding 32 ounces (1000.0), and fill the bottle 
with water. When the antidote is to be used, add the magnesia solu- 
tion slowly to the iron solution and shake together until a homoge- 
neous mass results. (See Iron, Hydrated, Sesquioxide of.) 

After the use of the antidote emetics should be used, opium should 
be administered to allay irritation and pain, and large draughts of 
water be given to flush the kidneys and dilute the poison. In the 
later stages the danger from arsenical poisoning arises from the changes 
produced in vital organs. 

Chronic poisoning by arsenic shows itself in great irritation of the air- 
passages, in the development of nephritis, in pigmentation of the skin, 
and in nervous symptoms due to inflammations of the nerves, such as 
patches of anaesthesia and localized loss of motor power. These 
anaesthetic areas are generally confined to the extremities, and extend 
only to the first or the second joint above. Sometimes the multiple 
neuritis caused by arsenic gives rise to symptoms which resemble those 
of locomotor ataxia to a very considerable extent. In other cases the 
action on the skin is the more marked, and various acute inflammatory 
conditions are produced. Arsenic often produces asthma in those 
exposed to it, by reason of the irritation it causes in the bronchial 
tubes. Chronic poisoning is to be treated by withdrawal from the 
exposure and by the use of iodide of potassium to aid in the elimi- 
nation of the arsenic. The special symptoms are to be treated by 
the application of electricity, tonics, out-of-door life, and such meas- 
ures as will improve the general condition of the patient. The pro- 
longed use of arsenic, according to de Schweinitz, may produce 
vitreous opacities. 



ASAFCETIDA—ASPIDIUM. 101 



ASAFCETIDA. 

Asafcetida, U. S., Asafetida, B. P., is a gum obtained by making 
an incision into the root of the Ferula foetida. It occurs in irregular 
masses of a dark-yellow or reddish color, which become still more 
red if exposed to the light and air. Asafcetida in tears is a term 
applied to the drug when it appears in the shape of drops or pearls, 
and is a form seldom seen. Its odor is penetrating and strong, and 
resembles that of garlic. When taken internally it causes a sensa- 
tion of warmth and acts as a stimulant and carminative in the ali- 
mentary canal. 

Therapeutics. — Asafcetida is used in medicine as a carminative 
which will particularly affect the lower bowel, and is useful in the 
intestinal indigestion of old persons when associated with flatulence, 
and in the flatulent colic of children. In the form of rectal injections 
it is of value for the relief of the tympanites of children and in that of 
adults during typhoid fever. It is also used as a stimulating expec- 
torant in the later stages of bronchitis. In the nervous irritability of 
children it is often of service. 

Administration. — Asafcetida is given in pills of asafcetida (Pilulce 
Asafoetidce, U, S.), of which two or three may be taken, each one 
containing 3 grains (0.18); the emulsion or milk of asafoetida {Emul- 
sum Asafoetidce, U. S.), the dose of which is ^ to 1 ounce (15.0-30.0) ; 
and the tincture (Tinctura Asafcetida?, U. S. and B. P), \ to 1 fluid- 
drachm (2.0-4.0). The suppositories contain what is equal to 40 
drops (3.0) of the tincture; and the plaster of asafoetida (Emplastrum 
Asafoetidce) is used where a faint counter-irritant and antispasmodic 
is needed. When intestinal indigestion and flatulence occur in old 
people the following pill is of service: 



R. — Ext. nucis vomicae gr. v (0.30). 

Ext. kolffi gr. v (0.30). 

Asafoetidfe gr. xl (2.6).— M. 

Ft. in pil. Xo. xx. 
S. — One night and morning. 

The B. P. preparation not official in the U. S. P. is Pilula Gal- 
bani Composites composed of asafcetida, galbanum, and myrrh ; dose 
5 to 15 grains (0.32-1.0). 

ASPIDIUM. 

Aspidium, U. S., Filix-mas, B. P., or Male Fern, the rhizome of 
Dryopteris Filix-mas (or Aspidium Filix-mas, B. P.), is employed in 
medicine as a tseniacide or remedy against the tape-worm, and is a 
very efficient and valuable drug under such circumstances, being, per- 
haps, the most reliable of all the vermifuges except pelletierin. When 
employed the directions and precautions given in the article on Worms 
must be strictly followed (Part IV.). 

Male fern taken in overdose is capable of producing poisoning, 
and according to Quivill causes when taken in such a irritation of the 



102 DRUGS. 

gastrointestinal mucous membrane and diarrhoea. If absorbed it acts 
on the central nervous system and causes paralysis, collapse, and death. 
The form and method by which it is eliminated are unknown. It may 
in overdose cause albuminuria and glycosuria. To go beyond 1J 
drachms of the oleoresin (6.0) at a dose is dangerous. 

Administration. — Male fern is rarely, if ever, used at present in 
its crude form, being employed most commonly in this country in the 
form of the oleoresin (Oleoresina Aspidii, U. S.)\ dose \ to 1 fluid- 
drachm (2.0-4.0) in capsules, or as follows: 

K --?S e t;ir dU } aanuW). 

Pulv. acaciae ^ss (2.0). 

Aq. destillat f £j (32.0).— M. 

S. — Take entire amount after fasting, and follow in two hours by a full dose of 
sulphate of magnesium. 

The dose of the liquid extract {Extr actum Filicis Liquiduni) of the 
B. P. is 15 minims to 1 fluidrachm (1.0-4.0). 

Katamaya and Okamoto, two Japanese investigators, and Poulssen, 
all state that castor and other oils should not be used after filix-mas is 
given, as oils increase the absorption of the active principle, and so pre- 
dispose to the development of poisoning. 



ASPIRIN. 

Aspirin is acetyl-salicylic acid, and occurs in white crystalline 
needles which melt at 135° C. and dissolve in water up to the strength 
of 1 per cent. It is easily dissolved in alkaline fluids. Owing to 
its chemical constitution, aspirin has been recently introduced into 
medicine as a substitute for the ordinary salicylates ; and as it is dis- 
solved and absorbed in the bowel, as is salol, it does not irritate the 
stomach. It is also not so disagreeable to the taste as are most of the 
salicylate preparations, and it is claimed is less likely to cause tinnitus. 
The dose of aspirin as a remedy for acute rheumatism is 10 to 15 
grains (0.65-1.0) three times a day or oftener. It can also be employed 
as an intestinal antiseptic. Aspirin may be given in capsules or in 
pill-form. Sometimes it is given in syrup of acacia and water, the 
mixture being well stirred or shaken before the dose is poured from the 
bottle. 

AZEDARACH. 

A ledaraeh is the bark of the Melia Azedarach, or Pride of China, 
as it is sometimes called. It is found in Syria, Persia, the north of 
[ndia, and in the Southern United States. 

The holies have but little toxic power, and children may eat of 
them largely without ill effect, but the bark is poisonous when taken 
in overdose, and produces symptoms resembling those of poisoning by 
Bpigelia or belladonna. It is employed as a remedy against the round- 
worm, and should be given in decoction made by boiling 2 ounces 
(60.0) of the drug in \\ pints (750 cc.) of water until there only 



BARIUM CHLORIDE— BELLADONNA. 103 

remains a pint (500 cc.) of liquid. Of this, from 1 to 2 tablespoonfuls 
(15.0-30.0) are to be given a child, and repeated every two hours 
until the bowels are opened. It has also been used as a fluid extract 
prepared by the ordinary means with alcohol, to which some white 
sugar should be added. The dose of this extract is a teaspoonful (4.0), 
and it is not to be repeated. The decoction is the best form in which 
to use the drug. 

BARIUM CHLORIDE. 

Barium chloride slows the heart very greatly, steadies its rhythm, 
and at the same time increases the volume of blood thrown out of 
the ventricle. It also increases blood-pressure, and Robert has, from 
a series of careful experiments, concluded that it brings about this 
change by an action on the muscular coats of the blood-vessels. 

If large doses are used in the lower animals, the heart suffers sys- 
tolic arrest from over-stimulation, and the strongest irritation of the 
vagus nerves fails to relax the systolic contraction. Still more inter- 
esting is the statement that this failure of the vagi to inhibit the 
heart is not the result of paralysis of these nerves, but is simply due 
to the excess of cardiac contractile power. The slowing of the pulse 
is not due to inhibitory influence, but depends solely upon the stimu- 
lation of the heart-muscle, although it would seem probable that the 
vasomotor stimulation, by increasing the arterial resistance, may be 
at least a factor in the reduction of the pulse-rate. 

In most works on chemistry barium is stated to be an irritant 
poison, but to produce such evidences of its presence the dose given 
must be extremely large, and many times greater than any amount 
useful for medicinal purposes. 

Therapeutics. — Barium chloride may be used in all forms of car- 
diac disease in Avhich failure of the heart-muscle is present. In the 
treatment of varicose veins it is said to be of value, both when given 
internally and applied locally over the distended vessels. 

A point worthy of remark is the character of the pulse-wave pro- 
duced. While its volume is increased, it does not give that sensation 
of tenseness to the finger that does the pulse produced by digitalis, and 
the pulse-wave seems to be very considerably prolonged — a fact that the 
sphygmograph also records. 

Administration. — The solution of barium chloride to be used inter- 
nally should have the strength of 5 grains to the ounce (0.43 : 30.0) 
of water, and of this 1 or 2 drachms (4.0-8.0) are to be given three 
times a day. 

BELLADONNA. 

Belladonna is botanically known as Atropa Belladonna, and is 
official in the form of the root (Belladonna? Radix, TJ. S. and B. P.) 
and leaves (Belladonna? Folia, TJ. S. and B. P.). Its popular name 
is "deadly nightshade." The drug belongs to a very large class of 
plants, namely, the Solanacece, which all have a similar physio- 
logical action. Belladonna contains an active principle in the form 



104 DRUGS. 

of an alkaloid known as atropine (Atrbpina, U. S. and B. P.), which 
is insoluble in water. The sulphate of atropine (Atropinoe Sulphas, 
U. S. and B. P.) is soluble, and is the salt commonly used. 

Physiological Effects. — In man, full medicinal doses produce flush- 
ing of the face, redness and dryness of the fauces, dilated pupils, 
sometimes an erythematous rash over the skin, rarely diplopia and 
delirium. If the dose be still larger, the delirium becomes very 
marked, and is wild and talkative. The pulse is rapid and wiry. The 
rash which appears resembles that of scarlet fever, but lacks the punc- 
tations. The skin may desquamate after the lapse of several days if 
the rash is severe. 

In children belladonna is usually borne very well indeed. When 
belladonna asserts itself in children and in susceptible adults the res- 
piration is quickened, the eyes become bright and the cheeks red, but 
lines of pallor reach from the malar bones to the angles of the 
mouth, giving to the face a curious expression. 

Absorption. — This drug is very rapidly absorbed. 

Nervous System. — Belladonna when given in medicinal amount 
approaching the toxic dose acts as a powerful excitant of the brain, 
producing talkative delirium. Locally applied, it depresses the periph- 
eral sensory nerves. 

When very large doses are given to animals, paralysis of the spinal 
cord comes on, followed by tetanic spasms, and finally by recovery. 
The primary loss of power is due to paralysis of the entire cord, 
and the second state, of convulsions, to the escape of the motor and 
sensory pathways from the paralysis before the inhibitory centres 
recover. As a result, any peripheral irritation causes violent explo- 
sions of motor power. 1 Even in large medicinal dose belladonna may 
be considered as a depressant to the motor nerves and as a quieter to 
sensory nerve-filaments. On voluntary muscles the drug has no effect, 
but upon unstriped muscles it acts as a sedative and antipasmodic. It 
distinctly lessens reflex action. 

Circulation. — Belladonna quickens the pulse by depression of the 
peripheral vagi and by stimulating the cardiac muscle and the accele- 
rator nerves. It produces a rise of arterial pressure by stimulating the 
vasomotor centre and by the increased heart-action which it causes. In 
poisonous doses it causes a fall of arterial pressure due to centric vaso- 
motor palsy, and depression of the muscular coats of the blood-vessels, 
but not to cardiac depression, as has been generally taught, for Reichert 
has proved that the drug is not a heart-depressant unless the dose is 
simply overwhelming. Sometimes when belladonna is given the pulse 
becomes slow, but in these cases the slowing is due to temporary stim- 
ulation of tin- peripheral vagi or to momentary depression of the cardiac 
motor ganglia. See Figs. 13 and 14. 

RESPIRATION.— Atropine is a stimulant to the respiratory centre 

1 If:, homely simile found useful by the writer in teaching, may be used, the 
inhibitory centres mavbe represented by a schoolmaster and the motor and sensory 
centres bv two boys. 1 he escape of chloroform in the room paralyzes them all, but, 

finally, the boys mover before their master and go off as truants' | convulsions) ; at 

lad the master inhibitory centres recovers, and order, or health, is restored. 



BELLADONNA. 



105 



in ordinary amounts, but recent careful studies show that its high 
reputation as a respiratory stimulant is not based either on clinical 
or experimental evidence. In many cases it fails to increase the 



Fig. 13. 




A, Atropine depresses the peripheral vagi and stimulates the accelerator nerves C. It raises 
arterial pressure by stimulating the vasomotor centre B. 



respiration at all, and it is certainly inferior to coifee and strychnine 
in the treatment of opium poisoning. In large doses it is a depressant 
and paralyzant to respiration, and produces death from respiratory 
failure due to paralysis of the motor nerves supplying the respiratory 
muscles, and probably by depressing the respiratory centres. 

Abdominal Contents. — Belladonna increases peristalsis by de- 
pressing the peripheral ends of the inhibitory fibres of the splanchnic 
nerves, and by diminishing any tendency to spasm on the part of the 
muscular coats of the intestine. 

Action on Secretion. — The drug decreases all the secretions of 
the body except the urine, which is sometimes increased in amount 
under its use. The decrease of secretion is due to paralysis of the 
peripheral nerve-filaments supplying the secretory cells of the 
glands. 

Bodily Heat. — When belladonna is used in large amounts there 
is nearly always a rise of temperature, which in children may amount 
to one or two degrees. In advanced poisoning the temperature rap- 
idly falls. 

Elimination. — Atropine is eliminated by the kidneys and bowels 
with extraordinary rapidity, and this is one of the reasons why death 
from poisonous doses of the drug is so rare. J. Harley asserts that it 
is entirely eliminated in two hours, and Meuriot states that not a trace 
of it can be found in twenty-four hours, and that it is partly destroyed 
in the liver. In a suspected case of poisoning the urine of the patient 
may be dropped in the eye of an animal, and, if atropine or belladonna 
has been taken, mydriasis will result. 

Eye. — On the eye belladonna produces dilatation of the pupil by 
stimulating the sympathetic nerve-fibres of the iris and paralyzing 



106 DRUGS. 



the oculomotor fibres peripherally, but the dominant action of the 
drug is undoubtedly exercised upon the circular muscular fibres of the 
iris, which are depressed (Jessup). Littauer has recently asserted 
that dilatation is not due to sympathetic stimulation, but Jessup's 
conclusions are generally accepted as correct, although the teaching 
as to the influence of atropine on the eye has changed several times 
in the last few years. Belladonna generally increases intra-ocular 
tension. 

Poisoning. — Poisoning by atropine is an exceedingly common occur- 
rence, but death is rarely produced by it, partly because its influence 
is not very actively exercised on vital parts and partly because it is 
eliminated by the kidneys almost as rapidly as it is absorbed from the 
stomach. Recovery has occurred after as much as 1 grain of atropine 
had been taken by a child of three years. Aside from the symptoms 
of mild poisoning detailed under the heading of physiological action, 
severe poisoning is characterized by deep sleep, preceded, it may be, 
by convulsions, violent delirium, blindness, and sometimes loss of 
speech. 

Treatment of Poisoning. — Poisoning by belladonna is to be 
treated by emetics, the application of external heat if the patient goes 
into collapse, and the use of strychnine if respiration fails. Opium 
may be employed in carefully graded doses as the physiological antag- 
onist ; but large doses are of doubtful service, particularly if the respi- 
rations are not in a satisfactory state. 

Therapeutics. — Belladonna is used to allay excessive secretion, to act 
as an antispasmodic, and to influence the circulatory apparatus when 
local inflammations are beginning, particularly in secretory glands, 
and to act as a vasomotor stimulant (Fig. 14). In cardiac palpitation 
small doses of belladonna internally, or its external use over the prsecor- 
dium in the form of a plaster or ointment, is very valuable. It is our 
most useful vasomotor stimulant in collapse. Belladonna is of value 
in neuralgias and in the pains due to irritated peripheral nerves. 

To check secretion in night-sweats it is one of the most powerful 
remedies we have, and it is useful in excessive idiopathic ptyalism, as 
Been in children, or in that due to mercurialization. In bromidrosis 
of the feet and other localized sweatings it is useful, and may be 
employed locally or taken internally for their cure. It is the most 
efficacious drug we have for checking the secretion of milk in an 
inflamed breast, and under these circumstances it is to be smeared 
over the gland in an ointment. Belladonna may be used in serous 
diarrhoea^ as it cheeks the disorder by stimulation of the splanchnic 
vasomotor filaments of the intestinal blood-vessels, which bein£ inac- 
tive permit a transudation of liquid into the bowel. 

Trousseau recommended as a local remedy 1 to 2 grains (0.05- 
0.13) of the extract of belladonna with 6 to 8 grains (0.30-0.40) of 
tonnic acid in leucorrhcea dependent upon disease of the uterine cer- 
vix. This Bhould be placed on a pledget of cotton and applied to 
the affected part daily, being allowed to remain all day. Ringer 
States that if pain is also present in these cases the following injec- 
tion is of value : 



BELLADONNA. 



107 



R . — Sodii bicarbonatis 33' (4.0). 

Tr. belladonna? f^ij (8.0). 

Aqua? dest q. s. ad Oj (500 cc). — M. 

This is to be injected into the vagina, the woman first being placed on 
her back with her buttocks raised, so that the drug may bathe the 
uterine cervix for some minutes. 

As an antispasmodic, atropine is to be used in acute torticollis, in- 
jected directly into the muscle itself, so as to act on its motor nerve- 
fibres ; it may be given in spasm of the intestine with cramps and grip- 
ing. In cramps in the legs and body, either as a local application 
by means of liniments or when employed internally, it is of service. 

Fig. 14. 



\j\i%ivVVi^ 



II 



III 



IV 




Tracing showing the affect of atropine as a vasomoter stimulant (after Schmiedeberg) : I. Nor- 
mal tracing of pressure (126) and pulse 28 in 10 seconds ; II. Pressure lowered by pilocarpine 
to 96, pulse 19 ; III. Tracing continued, pressure, 70 ; IV. Atropine has been given, raising 
the pressure to 145, pulse 30. 



In asthma of the spasmodic type belladonna is a sovereign remedy, 
particularly if it be combined with morphine. It may be used both 
as a prophylactic and as a cure during the attack. Belladonna-leaves 
may be smoked by asthmatics, by rolling them into a cigarette or put- 
ting them into a pipe. 

This drug is used in whooping cough at all ages and in all stages, 
but it must be given in large amounts in this disease to do any good. 

In spasm of the sphincter ani, whether it be due to fissure or 



108 DRUGS. 

other cause, belladonna in the form of an ointment or suppository 
is of value. In spasm of the urethra and bladder the drug may be 
used internally and externally, and in the former state the ointment 
should be smeared along the under surface of the penis every night. 
This treatment is also useful in chordee. In the colic resulting from 
the passage of hepatic and renal calculi belladonna in full dose will 
very often give relief. Where urinary incontinence depends upon 
spasm of the bladder belladonna should be used. (See Urinary Incon- 
tinence.) In dysmenorrhoea in nervous women, with spasm of the 
cervix uteri, it is of very great value applied as an ointment or in a 
vaginal suppository, or when given by the mouth. For the nervous 
cough of children and adults belladonna is one of the best remedies 
we have. In constipation it does good by depressing the inhibitory 
nerves of the intestine. It is also of value in laryngismus stridulus 
and in hiccough. In spasms from peripheral irritations belladonna is 
of value. In iritis atropine is used to dilate the pupil and prevent 
adhesions. The solution to be dropped into the eye should contain 1 
to 4 grains (0.065-0.26) of atropine sulphate to the ounce (30.0) of 
water. Atropine sulphate is also used for the purpose of producing 
mydriasis, before ophthalmoscopic examination, in solutions of the 
strength just given. It increases intra-ocular tension and is contra- 
indicated in glaucoma. When employed to act on the circulation it 
is to be used in shock and collapse from injury or in the course of 
severe disease. (See Shock.) During the progress of a case of 
pneumonia, typhoid fever, or other severe disease belladonna should 
be kept in the house, and administered freely if collapse or vasomotor 
relaxation suddenly asserts itself. Particularly is this true in the 
case of pneumonia. The vascular system after the crisis of this disease 
will often be found much relaxed, and heart stimulants do not seem to do 
much good. The administration of atropine or belladonna will dry the 
leaking skin, and by increasing the vasomotor tone produce great im- 
provement. In mastitis, or inflammation of the breast, even where pus 
is beginning to be formed, belladonna, if pushed, will give surprisingly 
good results if given internally and applied locally. In acute sore 
throat, when the pharynx has a sensation of rawness, while the local 
capillaries appear injected and red, belladonna is often of the greatest 
service if given in full dose, aborting the "cold." In exophthalmic 
goitre belladonna is thought to act by stimulating the sympathetic 
nerves, and certainly gives relief in some cases, particularly if combined 
with strophantus or digitalis. For the relief of local nerve-pains it 
is of value, and probably acts by quieting the irritated nerve. It 
should 1h; applied in those cases in the form of an ointment or plaster, 
and if the ointment is used it should be well rubbed into the part 
affected. 

In headache occurring in young persons, often due to ocular over- 
work, with pain in the eyeballs and forehead and a sensation as if the 
orbits woe too small for the eyeballs, belladonna is of service. In 
intt rcostal neuralgia or 'pleurodynia belladonna plasters may be applied 
to the spot where the pain is felt, with relief. 

Use of Atropine in Poisoning. — Atropine is a physiological antidote 



BENZOIN AND BENZOIC ACID. 109 

to opium, Calabar bean or physostigma, and jaborandi. In opium 
poisoning it acts as an antidote in all parts of the body except the eye, 
and in jaborandi poisoning the same facts hold true ; but in the former 
condition, although it has been largely used, it is no longer regarded 
as a satisfactory antidote ; and caffeine and strychnine are preferable. 
The condition of the pupil is not a guide as to the effect of atropine 
in opium poisoning, because opium acts centrically and atropine acts 
peripherally on the nerves governing the iris. Atropine should be 
used in aconite, antimony, and hydrocyanic acid poisoning for its 
stimulating influence on the vasomotor system, the respiratory centre, 
and the heart, and for the purpose of maintaining the bodily heat, the 
dissipation of which it retards by preventing vasomotor palsy and 
consequent dilatation of the peripheral blood-vessels. 

Atropine is a valuable physiological antidote to poisonous mush- 
rooms, particularly the Amanita, as it is antagonistic to their poison, 
muscarine. The dose given should be large, and if need be repeated. 

Administration. — The dose of the sulphate of atropine {Atropino? 
Sulphas, U. S. and B. P.) is ^ to To (0.0004-0.0015) of a grain. 
The alcoholic extract (Extractum Belladonna? Foliorum Alcoholicum, 
U. S.) is given in -J- to J grain (0.01-0.015) doses, and the tincture 
(Tinctura Belladonna? Foliorum, U. S., Tinctur a Belladonna?, B. P.) 
in the dose of 5 to 15 minims (0.3-1.0). Both these preparations are 
derived from the leaves. The fluid extract (Extractum Belladonna 3 
Radicis Fluidum, U. S.) is given in 1- to 2-minim (0.06-0.12) doses, 
while the extract (Extractum Belladonnas Liquidum) of the B. P. is 
given in ^- to 1-minim (0.015-0.05) doses. These preparations are 
derived from the root. Belladonna liniment (Linimentum Belladonna?, 
U. S. and B. P.), belladonna plaster (Emplastrum Belladonna?, U. S. 
and B. P.), and the ointment ( TJnguentum Belladonna?, U. S. and B. P.) 
are for external application. The preparations of the B. P. not official 
in the U. S. P. are Liquor Atropino? Sulphatis, dropped in the eye in 
the dose of J to 1 minim (0.03-0.06); Lamellae Atropino?, each of 
which contains 60 1 00 of a grain of atropine ; and TJnguentum Atropino? 
and Extractum Belladonna? Alcoholicum, derived from the root. 
Succus Belladonna?, B. P., is given in 5- to 15-minim (0.3-1.0) doses. 
There are also a green extract of belladonna, official in the B. P. under 
the name of Extractum Belladonna? Viride, and a suppository (Sup- 
positoria Belladonna?) which contains 1J grains of the extract. 

Contraindications. — Recent experiments show that belladonna de- 
creases gastric secretion very considerably in some persons. It is 
better, therefore, not to administer it just before or immediately after 
a meal, unless it is desired to reduce this secretion. 

BENZOIN AND BENZOIC ACID. 

Benzoin (Benzoinum, U. S. and B. P.) is a resinous balsam derived 
from the Styrax Benzoin, which is a native of Sumatra, Borneo, and 
Java. Benzoic acid is obtained by the sublimation of gum benzoin, 
or is prepared artificially, chiefly from toluol. The last method of 
preparation is not to be recommended, as the acid so made often dis- 



110 DRUGS. 

orders the stomach and leaves a disagreeable taste in the mouth. It 
is benzoic acid \vhich is generally used in medicine. 

Physiological Action. — Locally applied in concentrated form, ben- 
zoic acid is an irritant, and taken internally in excessive amount it 
causes a sensation of warmth and burning. It is eliminated as hippuric 
acid and increases the acidity of the urine. It is an antiseptic and 
germicide. In persons having an idiosyncrasy to benzoic acid it is 
not uncommon for urticaria to follow the use of the drug. Sometimes 
a papular or erythematous eruption appears. 

Therapeutics. — Benzoic acid is useful in the treatment of chronic 
cystitis with alkaline urine which is loaded with phosphates, and, 
combined with cannabis indica, acts well in the later stages of gonor- 
rJioea. Senator states that in a dose of 2 or 3 drachms (8.0-12.0) 
a day it is a specific in acute rheumatism, and thinks it equal to sali- 
cylic acid. When these doses are to be used, the benzoate of sodium 
should be employed, owing to its solubility. In acute larynyitis 
accompanied by great hoarseness the inhalation of steam laden with 
compound tincture of benzoin is of the greatest service. A table- 
spoonful (15.0) of this tincture should be placed in a pitcher of boil- 
ing water, the face held over the liquid, and a towel thrown over the 
head of the patient to retain the steam. The drug cannot be used in 
an atomizer, as it clogs the "tips.'' Taken internally, benzoic acid 
is useful as an expectorant in chronic bronchitis in the dose of 10 
grains (0.65) three times a day. 

Administration. — The dose of benzoic acid (Acidum Benzoicum, 
U. S. and B. P.) is usually 10 to 40 grains (0.65-2.6), but a drachm 
may be given in capsule. The gum itself is never used as such. 
The tincture (Tinctura Benzoini, U. S.) is given in 30-minim to 1- 
drachm (2.0-4.0) doses, and the compound tincture {Tinctura Ben- 
zoini Composita, U. S. and B. P.) is composed of benzoin, aloes, sto- 
rax, balsam of Tolu, and alcohol, the dose of it being 1 to 2 fluid- 
drachms (4.0-8.0). The preparations official in the B. P., but not 
in the U. S. P., are the troche (Trochiscus Acidi Benzoici) and 
Unguentum Cetacei. 

Adeps Benzoinatus (U. S.) and Benzoatus (B. P.), or benzoated 
lard, is a non-rancid basis for many ointments, notably that of zinc. 

BISMUTH. 

Bismuth is official as the subcarbonate (Bismuthi Subcarbonas, 
U. /S'.), the subnitrate (Bismuthi Subnitras, U. >S'. and B. P.), the 
citrate (Bismuthi Citras, U. S.), and the bismuth and ammonium 
citrate ( Bismuthi et Ammonii Citras, U. S.). The first and second are 
identical i 1 1 their dose (5 to 20 grains — 0.3-1.3) and action, and may 
be employed interchangeably. The third and fourth are more 
astringent and more irritating than the other two, and must be given 
in a smaller dose, which is 2 to 4 grains (0.1-0.2). 

Many years ago this drug was supposed to be capable of producing 
gastro-enteritis when given in large doses, but this was due to a con- 
tamination by arsenic. Bismuth may produce chronic poisoning after 
prolonged use on woiimU or when internally administered in excessive 



BISMUTH. Ill 

doses for some time. Ordinary doses are innocuous. As much as 4 
to 5 drachms a day may be given for a short time without harm. The 
changes which ensue when the drug is abused are the formation of 
black sloughs in the mouth and gastro-intestinal tract, desquamative 
nephritis, and albuminuria. The preparations of the B. P. not official 
in the U. S. P. are the Liquor Bismuthi et Ammonii Citratis, dose 
} to 1 fluidrachm (2.0-4.0), and the troche (Troehiscus Bismuthi 
Gompositus), 2 grains (0.1) in each. Bismuthi Oarbonas, B. P., is 
the same as the subcarbonate of the U. S. P. Bismuthi Oxidum, 
B. P., is given in the dose of 5 to 20 grains (0.3-1.3). 

Physiological Action. — Bismuth in the form of the subnitrate 
and subcarbonate is devoid of any effect upon the general system, and 
locally applied externally, or when given internally, exercises a mild 
astringent and protective influence upon mucous membranes. 

Therapeutics. — Bismuth is used as a mild astringent in large doses 
to cover the surface of inflamed mucous membranes and so to allay irri- 
tation. It is useful in irritative vomiting for this reason, and in diar- 
rhoea of a similar type in which the stools are serous. If the passages 
are mucous, castor oil should precede bismuth in order to rid the ali- 
mentary canal of the mucous secretion already poured out. It is very 
useful when combined with carbolic acid in serous diarrhoea, given in 
capsules containing 10 grains (0.65) of bismuth subnitrate and 1 minim 
(0.06) of carbolic acid. It is also to be used as a slow and feeble 
antacid. The Bismuthi et Ammonii Citras is very astringent, and 
should be used in chronic serous diarrhoeas in the dose of 5 grains (0.3) 
every two or three hours. The other preparations of bismuth are 
insoluble, and they should not be given in water, but this preparation 
is soluble and may be given in solution. Bismuth is of service in 
dyspepsia when lactic and butyric acid fermentation is present with 
excessive belching, and may be employed in gastralgia and gastric 
ulcer and gastritis as a sedative and astringent. Bismuth and am- 
monium citrate should never be employed if acute inflammation exists. 

When the salts of bismuth are used for any length of time, they 
cause the odor of garlic to appear in the breath, which is due to the 
presence of an exceedingly slight trace of tellurium in the bismuth. 
The stools are apt to become black under the influence of bismuth, and 
the tongue, if furred, may also be black about the centre when bismuth 
is used. 

Where there is chapping of the hands or cheeks from exposure to 
cold or wet the following prescription is useful : 

R. — Bismuthi subnitratis £iij (12.0). 

Zinci oleatis . ^iij (12.0). 

Lycopodii gij (8.0).— M. 

S. — Apply to the parts t. i. d. 

Bismuth Benzoate. 

This is a preparation which has been highly recommended in Ger- 
many, and to some extent in this country, within the last few years, 
in the treatment of chancroid. Under its influence the sore heals up 



112 DRUGS. 

with great rapidity and leaves a comparatively small cicatrix. It may 
also be used in the treatment of all specific sores and for the dressing 
of indolent or sloughing ulcers. Benzoate of bismuth, when properly 
applied, should be preceded by a careful washing of the diseased sur- 
face with a very weak bichloride-of-mercury solution, after which the 
bismuth is to be sprinkled over the wound and the entire surface cov- 
ered with cotton, which should be held in place by an adhesive strip. 
The only disadvantage in this dressing lies in the fact that it has to 
be changed once or twice in every twenty-four hours. Immediately 
after it is applied it may produce some tingling or burning, but this 
is never very severe- 
Bismuth Salicylate. 

Salicylate of Bismuth (Bismuihi Salicylas, B. P.) is a white, soft 
powder, insoluble in water, alcohol, ether, and chloroform, but soluble 
in acids. It is largely used by some practitioners as an intestinal 
antiseptic in cases in which there is diarrhoea due to fermentation or 
putrefaction. It may be given in powder, or, better still, in capsules, 
in the dose of 3 to 15 grains (0.25-1.0). 

Bismuth Subg-allate. 

Dermatol, or the subgallate of bismuth, was first used by Heinz 
and Liebrecht. It is a fine yellow powder which is unaffected by 
long exposure to light and air, is entirely oderless, and is supposed to 
contain 55 per cent, of oxide of bismuth. Its external uses are iden- 
tical with the uses of iodoform, and it probably acts in much the 
same manner as does the latter drug — namely, by so drying the 
Avound that it becomes an unfavorable site for the growth of germs. 
As dermatol is an astringent, it cannot be employed in the treatment 
of indolent ulcers, which need stimulation rather than an astringent 
influence, and it would seem probable on theoretical grounds that it 
is not to be compared to iodoform in the treatment of cases in which 
tubercular processes are going on. 

There is no doubt that dermatol is less poisonous than iodoform, 
but it must be capable of producing some untoward effects if used 
profusely for any length of time, since poisoning follows the pro- 
longed employment of bismuth preparations, as has been determined 
by Balzer, Dalche*, and Yillejean, for the symptoms of which see the 
article on Bismuth. 

Dermatol may be tried in cases of skin disease in which there is 
much secretion, as in weeping eczemas and similar states, either in 
tli<' form of a dusting-powder or in an ointment with vaseline or lano- 
lin in the proportion of i to 1 drachm to the ounce (2.0-4.0: 30.0). 
Sometimes its efficiency can be much increased by the addition of a 
drachm (4.0) of oxide of zinc to the prescription just given. 

Dermatol has been used with marked success in cases of jmrulent 
otitis media as ;■ dusting powder, and in other states requiring similar 
drying and astringenl effects. 






BITARTRATE OF POTASSIUM. 113 

Internally, it has been highly recommended in cases of fermenta- 
tive dyspepsia in the dose of 5 to 10 grains (0.3-0.65), but its real 
value in this condition is as yet undetermined. 



BITARTRATE OF POTASSIUM. 

Potassii Bitartras, U. $., Potassii Tartras Acidus, B. P., is some- 
times called " cream of tartar " or acid tartrate of potassium. It is a 
white gritty powder which may occur in rhombic crystals. Owing to 
its stability, it has been thought that it escapes from the body without 
oxidation, and so to differ from the other potassium salts formed by 
vegetable acids. 

Therapeutics. — The bitartrate of potassium is the most diuretic of 
the potassium salts, and is used in chronic nephritis with gin or com- 
pound infusion of juniper, for the purpose of removing dropsy. 
1 ounce (30.0) of the salt is added to a pint (500 cc.) of the infusion 
of juniper-berries, and the entire quantity taken in divided doses in 
twenty-four hours. In acute renal disease the drug should be used 
without the juniper. In large doses — \ ounce (15.0) — it acts as a 
watery purge, but is rarely so used. Where the urine is thick and 
alkaline, bitartrate of potassium is a useful remedy to neutralize it and 
make it clear and normal in appearance. 



BORAX AND BORIC ACID. 

Borax (B. P.), or Sodii Boras, U. S. y may be made by the action 
of boracic or boric acid upon soda, but the drug as it appears in com- 
merce in America is derived entirely from natural deposits found on 
the shores of lakes in California and Nevada. The natural product 
has to be purified before it is marketable. Borax is soluble in twelve 
times its weight of water. Both borax and boric acid have been sup- 
posed to act as efficient germicides in strong solutions, but this has 
been proved incorrect. They are antiseptics, however, even in weak 
solutions. Upon the body borax has little effect in any dose which is 
given for a medicinal effect. It is rapidly eliminated and renders the 
urine alkaline, and it is too rapidly absorbed from the alimentary 
canal to permit it to act as an intestinal antiseptic. Boric acid exercises 
even less effect upon the body than borax. 

In the form of a lotion boric acid has been used with some suc- 
cess as a remedy for erysipelas, and it may be similarly employed in 
burns and scalds. Borax may also be used as a gargle in diphtheria 
and in aphthous stomatitis, cancrum oris, and gangrenous stomatitis. 
In the treatment of pruritus ani and vulvoe and in bromidrosis and 
foetid sweating it is of great value when used as a wash. Strong solu- 
tions, locally applied, are useful in tinea tonsurans and tinea circinata. 

Borax has been used very largely in the treatment of epilepsy, with 
asserted success in some cases. Its employment is purely empirical. 
The dose used is from 8 to l-"» grains (0.5-1.0), gradually increased 
until it produces some disturbance in the alimentary canal. As the 



114 DRUGS. 

taste is very disagreeable to most persons, the drug should be used 
with liquorice, strong coffee, or syrup of bitter orange : 

R. — Sodii boratis ,^ss (15.0). 

Glycerin fjj (30.0). 

Ext. glycyrrhiz. fl f^ij (60.0). 

Aquse dest q. s. ad f^vj (180.0).— M. 

S. — Dessertspoonful (8.0) in water after each meal. 

If larger doses than 15 to 30 grains (1.0-2.0) a day are continued 
after the convulsions are decreased in number, there are two difficulties : 
1st, that the good effect is rapidly lost; and, 2d, that untoward symp- 
toms, such as nausea and diarrhoea, with emaciation and the forma- 
tion of a scarlatinal, eczematous, or papular eruption, appear. A 
peculiarity of the last two eruptions is that they are distributed around 
the joints. 

Borax should not be used with glycerin, as an acid reaction is apt 
to occur. 

A very useful wash for oral and nasal mucous membranes is 
" Dobell's solution," which is composed of — 

R'-godii boratis \ . (4 Q) 

Sodn bicarbonatis ( oj \ j 

Acid, carbolici gr. xxx (2.0). 

Glycerini f 5j (32.0). 

Aqua? purse Oij (1 litre). — M. 

• 

Boric acid (Acidum Borieum, U. S. and B. P.) is one of the most 
commonly used substances in eye-washes, either alone or with cocaine. 
When used with cocaine or other drugs it is employed to prevent the 
destruction of the alkaloid or glucoside, as the case may be, by the 
growth of mould. The following formula may be employed : 

R.— Cocain. hydrochlor gr. iv vel viij (0.25-0.5). 

Acid, boric gr. x vel xx (0.65-1.3). 

Aquae dest fgij (64.0).— M. 

S. — To be used by dropping into the eye. 

The following makes a very useful application for the skin of the 
face and hands to prevent chapping : 

li.— Acid, boric . . £j (4.0). 

Cerse albse ^j (4.0). 

Paraffini gij (8.0). 

01. amygdalae dulc fgij (8.0). — M. 

S. — To be thoroughly mixed and applied night and morning. 

Boric acid may be given internally in cystitis to render the urine 
acid, and is useful in the removal of freckles when applied as a wash to 
the skin. In persons having an idiosyncrasy to boric acid a bullous 
eruption of the skin may follow its use. 

Borated lint is made by dipping lint into a boiling saturated solu- 
tion of boric acid or borax. It makes a simple, inexpensive anti- 
septic surgical dressing, and contains nearly one-half its weight of 
the drug. Mel Boratis, />. /'., is not official in the U. S. P. It is 
used as a Local application lor sore mouth. 






BOROGLYCERIN-BROMIDES. 115 

BOROGLYCERIN. 

Boroglycerin (Grlycerinum Acidi Borici, B. P.) is a liquid made by 
mixing 62 parts of boric acid with 92 parts of glycerin in a tarred 
porcelain capsule at a temperature of not more than 302° F. The 
acid is added to the glycerin gradually, with constant stirring. When 
the mixture has been reduced to the weight of 100 parts, it is poured 
on a flat surface wet slightly with petroleum, and on hardening is cut 
into blocks, which should be placed at once in a well-stoppered bottle. 
When used for medicinal purposes the glycerite of boroglycerin 
(Grlyceritum Boroglycerini, U. S.) should be employed, which may 
be made by adding 1 ounce (30.0) of the boroglycerin in solid form 
to 1 ounce (30.0) of glycerin and heating in a dish while stirring. It 
is soluble in water. Locally the glycerite of boroglycerin is used as 
an antisepsic and as a vehicle for carbolic acid, chrysarobin, and the 
vegetable alkaloids in the treatment of skin diseases, and in diseases 
of the eye, such as purulent ophthalmia. 



BROMIDES. 

Bromides of Potassium, Sodium, Lithium, Calcium, Gold, Nickel, 
Ammonium, Strontium, and Hydrobromic Acid. 

Bromide of Potassium. 

Bromide of Potassium (Potassii Bromidum, U. S. and B. P.) is 
the most commonly used and an important member of the group 
above named, and will, therefore, be spoken of before the others. 

It is prepared by precipitating freshly-made bromide of iron with 
pure carbonate of potassium, or by a process more readily carried out 
and recommended by the B. P. It occurs in colorless transparent 
crystals, which are stable in dry air, but absorb moisture in a damp 
atmosphere. It is very soluble in water, but less so in alcohol. This 
bromide has a salty taste, and is distinctly irritant to mucous mem- 
branes if locally applied in concentrated form. A certain portion of 
its depressant influence, particularly when it is given for long periods 
of time, depends upon the potassium as much as upon the bromine, and 
for this reason the sodium salt is preferable. 

Physiological Action. — Bromide of potassium has an action upon 
the animal economy which is clearly defined and closely followed by 
all the other bromide salts, so that what is said in this place concern- 
ing its effects may be taken as representing the whole class of bromides, 
except in the instances where slight differences exist, which will be 
pointed out under the various names of the respective salts. 

Bromide of potassium when taken internally in full doses produces 
drowsiness, sleep, and a decrease in all the reflexes. (See Effects of 
Prolonged Use.) 

Nervous System. — The bromide of potassium acts as a distinct 
depressant to the motor and to the intellectual portions of the cortex 



116 



DRUGS. 



cerebri. It slows the development of thought and decreases the excita- 
bility and power of the motor cells of the brain (Albertoni). Upon the 
spinal cord it acts as a marked sedative, affecting chiefly the sensory 
tracts, and causing thereby loss of reflex action and a decrease in the 
ability to recognize pain. It also depresses, but to a less extent, the 
motor pathways in the cord. Motion is maintained after sensations to 
pain and reflexes are lost. The drug depresses the peripheral parts 
of the sensory nerves, and under very large doses the motor nerves 
and muscles are similarly involved. 



Fig. 15. 




a 




A, The bromides depress the motor areas and B, intellectual areas in the brain; C, they 
depress the sensory tracts in the spinal cord ; D, they depress reflex action by depressing 
the sensory cells in the cord (a). 



Circulation. — If the drug be injected in ordinary dose into the 
jugular vein, it causes at once a fall of arterial pressure and pulse- 
rate. These changes are due to a direct action of the bromine and 
the potassium upon the heart. When given to man in therapeutic 
doses by the mouth, its circulatory effect is so slight as not to be 
worthy of consideration unless the dose is very large and repeated. 

RESPIRATION. — In toxic dose bromide of potassium is a depressant 
to the respiratory centre. In medicinal dose it does not affect the 
breathing, except when the amounts given are large and the drug per- 
sistently administered, when the breathing becomes slower. 

DIGESTION. — The bromides may disorder the stomach by irritating 
its mucous membrane or by so decreasing reflex action that the proper 
secretion of gastric juice is retarded, with the result that digestion 
does ii"! i.ike place with sufficient rapidity. For similar reasons they 
may cause constipation. The hydrochloric acid of the gastric juice 
Bets free the bromine. 

TEMPERATURE. — No effect upon this function is noted unless the 



BROMIDES. 117 

dose be enormous : when such a dose is given the bodily heat is pro- 
gressively diminished, the fall of temperature being probably due to the 
circulatory and nervous depression produced, associated with the general 
failure in vital power. 

Elimination. — The drug escapes unchanged very slowly with all 
the secretions, and is found in the sweat, urine, tears, semen, milk, and 
faeces. 

Tissue-waste is decreased when the animal economy is under the 
influence of one of the bromides. 

Therapeutics. — From what has been already said, it is evident that 
bromide of potassium is a remedy to be devoted almost entirely to the 
treatment of disorders of the nervous system, and its uses are, there- 
fore, as various as the manifestations of perversion of nervous action 
can be various. In a word, it may be said that bromide of potassium 
is to be used wherever over-excitement of nervous protoplasm is pres- 
ent, but never where nervous symptoms are due to depression. 

In epilepsy, which, to the best of our knowledge, is due to explosive 
impulses arising in the cerebral cortex, it is one of the best drugs we 
have if given in sufficient dose ; and in all forms of minor spasm, due 
to heightened reflex activity, it is of service. Care should be used 
in giving this drug in epilepsy, that maniacal excitement does not 
supplant the attacks of epilepsy. (See Epilepsy, Part IV.) In cases 
of spasmodic contractions, in the treatment of hysterical females, in 
nervous startings and alarm at sudden noises in adults and children, 
and in the nervous symptoms accompanying pregnancy and the meno- 
pause the bromides will be found of great value. The following pre- 
scription was recommended very highly by Goodell, and will be found 
of service in the latter states : 

R. — Ammonii bromidi ^ij (8.0). 

Potassii bromidi ^iv (16.0). 

Spts. ammon. aromat f^vj (23.0). 

Aquae camphorse . q. s. ad f^vj (180.0). — M. 

S. — A dessertspoonful (8.0) to a tablespoonful (16.0) every four hours. 

In headaches due to uterine trouble the pain is often felt at the top 
of the skull or at the back of the neck near the occiput. The cause 
of this trouble will sometimes be found to be in the cervix uteri, and 
relief under these circumstances can only be obtained when the uterus 
is treated and the bromides administered. 

In convulsions in children and adults, combined with chloral, bro- 
mides are most efficient, and are sometimes of service in incontinence 
of urine due to vesical spasm. In seminal emissions due to a morbid 
excitability of the centres in the spinal cord bromide of potassium is 
one of the best remedies we have, and in satyriasis and nymphomania 
it is of great service. 

In cases where undue irritability of the pharynx and larynx prevents 
examination of these parts, one or two full doses will render an exami- 
nation easy of performance by decreasing the local reflex activity. 
This is a useful point to be remembered in relation to the treatment 
of pharyngeal and laryngeal disease. 



118 DRUGS. 

In cases of acute laryngitis full doses of the bromides (60 to 120 
grains [4.0-8.0] a day) are very useful to allay the pain and hoarseness. 

The bromides are found to be of service in the laryngeal crises of 
locomotor ataxia, the explanation of this fact being as follows : The 
adductor centre of the larynx is situated in the brain, and the abduc- 
tor centre in the spinal cord. The first closes the larynx, the second 
opens it, and in health they maintain a patulous tube by their oppo- 
sition. In disease the spinal centre (the abductor or opener) fails, 
and the adductor in the brain being unopposed, produces closure of 
the tube with disastrous results. The bromide, by quieting reflex 
action, as well as depressing the adductor centre in the cerebral cor- 
tex, prevents this accident. 

In whooping cough with much mucous exudation the drug is rarely 
of benefit, and had better not be used. In laryngismus stridulus or 
any form of spasm depending upon local irritation the local trouble 
must, of course, be removed if possible and the bromides given. In 
teething the drug may be used to decrease reflex irritation and prevent 
convulsions, and it will decrease the night-screaming of children — 
which is often due to bad dreams — to a very extraordinary degree, 
even if the dose be quite small. As a soporific for the insane and in 
the insomnia of the overworked and that of nervous women the bro- 
mide of potassium is of great service, but ought to be vised as a tem- 
porary measure only. (See Insomnia.) It may also be employed 
with good results in chronic alcoholism and morphiomania, given in 
doses of 40 to 60 grains (2.6-4.0). In migraine and neuralgia 
due to eye-strain or other nerve-strain, combined with caffeine the 
bromides are almost specifics. The caffeine seems to stimulate 
the depressed nerve up to the normal level, and the bromide to 
deaden the perception of the pain. The following is a most val- 
uable remedy in migraine, and even in sick headache. It ought 
not to be used in bilious headache, which will often be made worse 
by it: 

R. — Antipyrini gr. xxv (1.6). 

Caffeime citratae gr. x (0.65). 

Potassii bromidi gr. xxv (1.6). — M. 

Ft. in chart No. v. 
S. — One powder as needed. 

In the treatment of dysmenorrhea and monorrhagia, particularly 
in young subjects, the bromides are also of service. (See Dr. Goodell's 
prescription just given.) When the flow is too great at such a period, 
the drug should be begun a week before the expected epoch, and kept 
ap in the dose of 5 to 10 grains (0.3-0.65) night and morning. In 
cases where the epochs follow one another too closely the drug should 
be used continuously. After an apparent cure ensues the bromide 
should be used for a few periods to avoid a relapse. For seasickness 
the bromides are the best prophylactics we possess, and should be 
used in the dose "1" 5 to L0 grains (0.3-0.65) three times a day for 
several days before the patient sails in order to quiet the vomiting 



BROMIDES. 119 

centre. After sea-sickness begins they should not be given in ordi- 
nary solution, but in an effervescing draught made as follows : 

R— Acid, citric £ij (8.0). 

Aquse dest f ^iv (120.0).— M. 

Ft. sol. 

R.— Potassii bromidi . # gj (4.0j. 

Potassii bicarbonatis 3j (4.0). 

Aquae dest f|iv (120.0).— M. 

Ft. sol. 
S. — A tablespoonful (16.0) of each of these solutions should be added to one another 
and taken during effervescence. 

This prescription will also be found of value in the persistent vom- 
iting of pregnancy and in that following prolonged etherization or 
other states. If the vomiting is excessive, the dose ought to be 
reduced to 2 teaspoonfuls (8.0) of each solution, and be given every 
half-hour until half of each mixture is taken or the patient is relieved. 
In cases where this cannot be retained a rectal injection of the follow- 
ing will be found of value : 

R. — Sodii bromidi . . . gr. xxx vel gj (2.0-4.0). 

Tinct. opii deodorat TT^ xxx (2.0). 

Aqujeamyli fjvj (180.0).— M. 

S. — To be injected gently into the empty rectum and retained as long as possible. 

This method is the most reliable plan that can be followed. 

Bromide of potassium may be used to prevent the development 
of symptoms of cinchonism, which often ensue after the use of quinine 
and salicylic acid, and it is said to prevent the nausea and depression 
so apt to follow the use of opium. 

Administration. — The dose of bromide of potassium is from 5 to 
120 grains (0.3-8.0) a day. It should be given at long intervals, as 
it is slowly absorbed and very slowly eliminated. After the patient 
is fully under its influence its effects can be maintained by smaller 
doses. The best way to order it is in a watery solution with a little 
syrup. 

Use of Bromides in Poisoning. — Bromides are useful in all convul- 
sive attacks consequent upon the ingestion of poisons, and they may 
be used to allay any nervous symptoms arising from this cause, which 
are of an excited nature. 

Poisoning. — Acute poisoning by the bromides is rare, but if half to 
one ounce is taken they produce a sense of warmth in the epigastrium, 
general feebleness, frontal headache, stupidity, aphasia, and amnesia. 
The pulse-rate decreases 15 to 20 beats a minute ; the pulse is irreg- 
ular and compressible. Recovery takes place, as a rule, unless pul- 
monary oedema sets in. 

Effects of Prolonged Use, or Bromism. — After the drug has been used 
for some time in large doses acne appears about the face and extends 
over the entire body ; the breath becomes foetid, the patient dull, ex- 
pressionless, and heavy, remaining buried in sleep during nearly every 
hour of the day. During this time he can be aroused, but at once falls 



120 DRUGS. 

to sleep again. The walk becomes weak and feeble, the movements 
slow and painfully prolonged. Taste is lost and hearing is benumbed, 
while the intellectual faculties of the brain are almost in abeyance. Loss 
of sexual power is an early symptom. In other cases evidences of men- 
tal aberration develop, the patient becoming irritable, morose, and even 
homicidal. Sometimes, however, we find melancholia and hallucina- 
tions, and rarely exalted ideas. 1 In still others a dangerous suffocative 
bronchitis develops, the patient may become profoundly cachectic, or the 
condition may resemble typhoid fever. The acne may be put aside to 
some extent by the use of arsenic, and when the bromides are given to 
women this drug may be given simultaneously to prevent the eruption. 
As Fowler's solution is compatible with the bromide in solution, it 
is the best form of arsenic to employ. As the acne is due to a torpid 
state of the skin-glands, it is also well in these cases to order the patient 
to wash with warm water and castile soap every night, and afterward to 
dry the face by a good rubbing with a rough towel. Fere has recently 
asserted that the maintenance of intestinal antisepsis by the use of 
naphtol or salol will prevent the development of acne and digestive 
disorder when the bromides are given. 

Contraindications. — The bromides are contraindicated wherever 
there is general asthenia and feebleness of the nervous system, as, for 
example, in post-typhoidal and post-puerperal insanity. In senile 
softening of the brain they are also harmful. When the mucous 
membrane of the gastro-intestinal tract is irritated, they do harm. 
AVhen the patient is subject to acne they should be used with caution 
or avoided. 



Bromide of Ammonium. 
(See Ammonium Bromide.) 

Bromide of Calcium. 

Calcium Bromide (Calcii Bromidum, U. S.) was introduced into 
medicine as a nervous sedative and hypnotic, and was thought at one 
time to be an efficient substitute for the bromide of potassium. Its 
action on the nervous system is virtually identical with that of the 
potassium salt, and it has been found to be far less irritant and 
depressant than the latter. For some unknown reason it has never 
won the confidence of the profession, but it may be given with very 
good results in the dose of from 30 to 90 grains (2.0-6.0) a day, or 
even more in cases which are not readily affected by bromides. It 
may be employed in hysteria and epilepsy and in all the condi- 
tions in which the other bromide salts are indicated. It is some- 
times of value combined with the potassium salt, since under such 
circumstances better results are gained than if a single salt is 
employed. 

1 Sec Collective Investigation by author in the Therapeutic Gazelle of June 15,1897; 
also article on Epilepsy, Pari I V. 



BROMIDES. 121 

Bromide of Gold. 

The Bromide of Gold has been employed in epilepsy by a number 
of clinicians with great success in the dose of from -J- to -J- grain 
(0.015-0.03) three times a day in pills. Physiological studies have 
proved that the drug is a direct sedative to the motor cells in the 
cortex cerebri. 

Bromide of Lithium. 

Bromide of Lithium (Liihii Bromidum, U. S.). This salt is much 
weaker than the other salts, and must be given in larger dose. Dr. 
S. Weir Mitchell states that it is of value in epilepsy after the potas- 
sium salt fails. The dose is 30 to 90 grains (2.0-6.0) a day. 

Bromide of Nickel. 

This is a green salt quite irritant to the stomach. The author has 
made an experimental study of the bromide of nickel, and found it 
practically identical with the bromide of potassium in physiological 
action. It should be given well diluted or in an effervescing draught, 
as it is apt to disorder the stomach if used in concentrated solution. 
The effervescing form of the drug is made by mixing the salt with 
bicarbonate of sodium and tartaric acid, moistening with alcohol, 
passing the moist powder through a sieve, and then drying it in a 
warm closet. 

Bromide of Sodium. 

Bromide of Sodium (Sodii Bromidum, U. S. and B. P.). This 
salt is to be used in every instance where bromide of potassium can 
be employed. Its dose is the same, although it is asserted to be a 
little weaker physiologically, grain for grain, than the potassium salt. 
It is far less apt to disorder the stomach, and is not so generally 
depressant as is the bromide of potassium. 

Bromide of Strontium. 

(See Strontium.) 

Hydrobromic Acid. 

Hydrobromic Acid is an extremely irritant preparation, but is 
thought to be less apt to cause acne and other untoward effects than 
the other bromides. It is only to be used in the form of the official 
dilute acid (Acidum Hydrobromicum Dilutum, U. S. and B. P.), and 
to be given in the dose of from 1 drachm to J an ounce (4.0-15.0) 
well diluted with sweetened water. It is highly recommended by 
de Schweinitz and others for headaches due to eye-strain in nervous 
women. 

Bromide of Ethyl. 

(See Ethyl Bromide.) 



122 DRUGS. 



BROMINE. 



Bromine (U. S.) is a dark-red liquid of an excessively pungent 
odor, like that of chlorine, possessing very extraordinary power as a 
caustic when applied to the tissues of the body. It is the most severe 
causiic we possess, and penetrates very deeply. It may be applied in 
hospital gangrene and other large sloughs by means of a glass rod. 
Bromine should be kept in glass-stoppered bottles in a cool place. 

BROMOFORM. 

Bromoform, or Tribromomethane, is a clear, colorless liquid hav- 
ing a peculiar odor and sweet taste. It is readily soluble in alcohol, 
but slightly so in water. Bromoform, which is to be used medicinally, 
should be protected from sunlight and air, and must be free from 
color and from acid. 

Therapeutics. — Although bromoform has been found capable of 
producing anaesthesia when given by inhalation, its employment in 
medicine is practically confined to the treatment of whooping cough, 
when it is given internally in the dose of 2 to 5 minims (0.1-0.3) three 
times a day for the relief of the spasmodic cough. Bedford has sug- 
gested the following formula for its internal use : 

&.— Bromoform '. TTLxvj (1.0). 

Alcohol fgij (8.0). 

Glycerin f.^ij (45.0). 

Tinct. cardamomi comp q. s. ad f^ij (60.0). — M. 

S. — Teaspoonful (4.0) t. d. in water. 

This prescription should be put up by adding the ingredients in the 
order named. 

Bromoform tends to depress the vasomotor system, but does not 
seem to depress the heart itself. While it seems to possess therapeutic 
value, the large number of cases reported in which it has caused alarm- 
ing symptoms has prevented the author from employing it. 

BRYONIA, or BRYONY. 

Tli is is a remedy very largely used by irregular physicians, and is 
probably too much ignored by reputable physicians, for it possesses 
very greal power, and often relieves conditions which are obstinately 
persistent under other treatment. It is the root of Bryonia alba or 
Bryonia dioica (!'. S.). The only official preparation is the tincture 
( Tinctura Bryonia U. S.). The dose of the powdered root as a 
drastic purge is 10 to 40 grains (0.6-2.4). 

Physiological Action. — In overdoses bryonia acts as a hydragogue 
cathartic and gastro-intestinal irritant. On serous membranes it 
exercises an irritanl influence, and may produce symptoms of menin- 
gitis when given in poisonous doses. In moderate doses bryonia 
causes aorae flushing of the face and neck and headache in susceptible 
persons. The drug needs studying from a pharmacological point of 
view. 



BYRONIA, OR BRYONY— BUCHU. 123 

Therapeutics. — Although one of the oldest of remedies, bryonia has 
been given a new impetus by the homoeopaths, who employ it in a 
number of affections. In the treatment of dyspepsia depending upon 
gastric and intestinal atony or the abuse of alcohol or other similar 
causes bryonia often gives relief. Its influence is exerted through the 
irritant effects it produces, for by this means it stimulates or spurs the 
atonic digestive glands to increased activity. For this reason it has 
been found particularly useful in children who suffer from constipation 
resulting from insufficient secretion on the part of the intestinal glands. 
When the passages are dry and friable and resemble in character those 
of a dog, bryonia is of great value. The dose for a child is about 
10 to 30 minims (0.65-2.0). The drug has been praised as a remedy 
in the treatment of rheumatism and in pleurisy, but little is recorded 
as to its real value in these diseases. In pleurisy with effusion drastic 
doses have been used, but the saline purgatives are safer and more 
efficacious remedies. 

Administration. — -The dose of the tincture of bryonia (Tinctura 
Bryonia?, U. S.) is from 1 to 2 fluidrachms (4.0-8.0) as a laxative; 
but the so-called mother-tincture of the homoeopaths is perhaps the 
best preparation for ordinary use. The proper amount to be used in 
the treatment of a case of dyspepsia is from 5 to 40 minims (0.3-2.4), 
unless the mucous membranes are very torpid, when this quantity may 
be increased. 



BUCHU. 

Buchu (U. S.) is derived from Barosma betulina, a plant of Africa. 
It contains a volatile oil, which is probably the active principle, and 
a bitter extractive. It is official, under the name of Buchu Folia, 
in the B. P. 

Therapeutics. — Buchu is used when it is desired to affect the mucous 
membranes of the genito-urinary tract which are chronically diseased, 
and particularly when these parts are below their normal tone. It 
does not increase the urinary flow to any great extent, but acts on the 
mucous membrane of the genito-urinary passages as a stimulant. It 
is employed in pyelitis, cystitis, and vesical irritation of a chronic 
type. The following prescription is useful : 

R. — Potassii citratis ^iv (16.0). 

Spt. chloroformi fgiij (12.0). 

Tinct. digitalis TT^xxx (2.0). 

Infusi buchu . q. s. ad f|viij (256.0).— M. 

S. — Two tablespoonfuls (32.0) three times a day. Shake the bottle before using. 

If the urine is continually highly acid, muddy, laden with salts, 
and productive of incontinence by reason of the vesical irritation 
which it produces, buchu in the form of the fluid extract, in the dose 
of a teaspoonful (4.0) three times a day, combined with an equal 
amount of sweet spirit of nitre and 20 grains (1.3) of acetate of 
potassium, will be of great service. For a child the dose of the fluid 



124 DRUGS. 

extract should be about 10 to 30 minims (0.6-2.0). If the vesical 
irritation is acute, buchu is contraindicated. 

Administration. — The fluid extract (Extraction Buchu Fluidum, 
U. S.) is the only official preparation, and it should be always well 
diluted before it is given, in the dose, to an adult, of 1 drachm (4.0) 
three times a day. The infusion is not official, but is made by adding 
1 ounce (30.0) of the leaves to a pint (500 cc.) of water. The dose 
of this is J ounce (15.0) to 1 ounce (30.0). The official B. P. 
preparations are the infusion {Infusum Buchu), dose 1 to 4 fluid- 
ounces (30.0-120.0), and the tincture (Tinctura Buchu), dose 1 to 2 
fluidrachms (4.0-8.0). 

CACTUS GRANDIFLORUS. 

This is a plant of Mexico and the West Indies. There are other 
species of Cactus possessing medicinal power, but the Cactus grandi- 
florus is the most active so far as a medicinal effect upon the heart is 
concerned. 

Cactus grandiflorus is best given in the form of the tincture or the 
fluid extract made from the green plant. 

Physiological Action. — The drug has been studied by Myers and 
Boinet and Teissier, who have found that it causes a distinct increase 
af arterial pressure, but does not slow the pulse, sometimes increasing 
its rapidity. Myers has also shown that the drug is a stimulant to 
the vasomotor centres and to the motor ganglia of the heart-muscle. 
Cactus grandiflorus also acts as a stimulant rather than a depressant 
to the spinal cord. 

Therapeutics. — Cactus grandiflorus has proved itself a good sub- 
stitute for digitalis in certain diseases of the circulatory apparatus, 
such as cardiac palpitation and iveakness. It has also been found 
very serviceable as a remedy in cardiac failure the result of valvular 
disease, but in all such cases seems to act best when added to some 
more powerful drug, such as digitalis, as it takes the part of an 
adjuvant. Cactus also acts well in some cases of angina pectoris. 

Administration. — The dose of the tincture of cactus is 2 to 8 minims 
(0.1-0.4) and of the fluid extract 2 to 4 minims (0.1-0.2). 

Untoward Effects. — It is claimed that these do not occur, and that 
the drug never produces a cumulative effect. 

CAFFEA. 1 

Caffeine {Caffeina^ U. 8. and B. P.) is an alkaloid derived from 
the berries of Oaffea Arabica, which also contain, upon roasting, an 
empyreumatic oil, caffeol or caffeone. Caffeine is usually employed 
in medicine aa caffeine and the citrated caffeine (Caffeina Citrata, 

V. >S'. ; Caffeina' Citrax, B. P.). Citrated caffeine is not regarded by 

1 Theine, derived from ten, caffeine, the active principle of coffee, and the alkaloid 
of guarana from South America, -ire chemically identical. Much of the caffeine of 
commerce i- really theine, although it is claimed that pure theine has a very different 
physiological action. 



CAFFEA. 



125 



chemists as a chemical compound, but as a mixture of citric acid and 
caffeine; therefore " citrate of caffeine" is an incorrect term. It is 
soluble in 3 parts of water. If more water is added, it is partly precipi- 
tated, but when 25 parts are added it is redissolved. In the U. S. P. 
another official preparation of caffeine, the Caffeina Oitrata Ufferves- 
eens (Caffeina? Citras Uffervescens, B. P.), has been introduced as an 
agreeable preparation for use in cases of headache, particularly if 
combined with one of the bromides and antipyrin. The dose is from 
1 to 4 drachms (4.0-16.0). 

The empyreumatic oil, of which there is about one-half to one tea- 
spoonful in each well-made breakfast-cup of coffee, has no physiological 
effects. It is perhaps the cause of the "biliousness" sometimes pro- 

Fig. 16. 




Caffeine dilates blood-vessels of the Malpighian tuft, and stimulates the secreting epithelium 
lining the uriniferous tubules. 



duced by the habitual use of coffee, due to the faulty digestion of this 
oil, which is also prone to disorder the digestion if taken alone. 

Physiological Action. — JSIervous System. — On the nervous system 
caffeine acts as a rapidly-acting stimulant, exerting its chief influence 
on the brain and spinal cord. By its cerebral effect it causes increased 
rapidity of thought, and by its influence on the spinal cord it increases 
reflex activity, and for this reason is said to make people "nervous." 



126 DRUGS. 

It is important to remember that it has no effect on brain protoplasm 
except to stimulate it, and that ultimately a brain driven along by 
caffeine breaks down by the concentration of its energy for the time 
being in one effort. 

Circulation. — Caffeine has been supposed to increase the pulse- 
rate and blood-pressure by stimulating the heart-muscle, but from 
recent studies in this country and abroad it would seem probable that 
these changes are indirectly produced and due solely to its stimulating 
action on the nervous system. Clinically, it certainly seems to raise 
the blood-pressure in almost every instance where it is used. 

Kidneys, Tissue-waste, and Elimination. — Caffeine increases 
diuresis by causing dilatation of the renal vessels, particularly in the 
glomerules, and by preventing the absorbent action of the tubules. It 
also exerts a direct stimulating influence on the secretory epithelium 
of the kidney, and therefore increases the amount of solids as well as 
of the liquids in the urine. Upon tissue-waste the drug acts as a de- 
pressant, and is therefore a conservator of the tissues. It is oxidized 
and destroyed in the body. 

Respiration. — Caffeine acts as a powerful stimulant to the respira- 
tory centre. 

Therapeutics. — Caffeine is a valuable cardiac stimulant and tonic 
as well as a renal stimulant. It acts equally well in cardiac and renal 
dropsies for this reason, and is an invaluable remedy in such cases. 
So useful is caffeine in cases of cardiac disease that it has largely sup- 
planted digitalis in the hands of some practitioners. In acute renal 
inflammation it is contraindicated, because all stimulants are contra- 
indicated when the part they influence is inflamed. In opium-poison- 
ing, owing to its stimulant effect on the respiratory centre, caffeine is 
very valuable. Under these circumstances it may be given by the 
mouth or rectum in the form of strong black coffee, which will also aid 
in keeping the patient awake and add heat to the body, which is often 
very cold. A cup of strong black coffee is often useful in relieving a 
paroxysm of asthma. In headache due to nerve-strain caffeine com- 
bined with antipyrin and one of the bromides is of the greatest service. 
( See Neuralgia.) 

Roasted coffee is sometimes used to mask the taste of disagreeable 
medicine. After it is roasted and ground it may be employed as an 
antiseptic and deodorant dressing for wounds when the common anti- 
septics are not obtainable. 

Administration. — The ordinary dose of caffeine is 2 to 4 grains 
(0.1-0.2). fe 

Caffeina^U. 8. and B. P., cannot be used hypodermically, owing 
to its decomposition in the presence of water. The following" solution 
may, bowever, be used hypodermically: Salicylate of sodium, 30 
parts; caffeine, 40 parts; and distilled water, 60 parts; or, in other 
instances, the following preparation, recommended by Huchard, may 
be employed: Benzoate of sodium, 45 grains; caffeine, 30 grains; 
distilled water, 75 grains. This mixture is to be heated, and 10 
minims (0.65) given at a dose. 



CAJUPTJT OIL— CALCIUM. 127 

Untoward Effects. — Caffeine often produces so much insomnia when 
given in cases of cardiac disease that its use has to be discontinued. 
If its use is persisted in, it may produce a condition of delirium closely 
resembling that of alcoholism ; and if too large doses are used, or it is 
too frequently repeated, it may cause a decrease in urinary flow by 
causing spasm of the renal vessels. The writer has also seen a marked 
rise of temperature follow its use in the dose of 2 grains (0.1) three 
times a day, but this is very unusual. In certain persons the habitual 
use of coffee may cause insomnia, tremors, palpitation, tinnitus aurium, 
gastralgia, and emaciation. 

CAJUPUT OIL. 

Oil of Cajuput {Oleum Cajuputi, TJ. S. and B. P.) is a volatile oil 
distilled from Melaleuca Leucodendron, a tree of the Molucca Islands. 
It is a stimulant, and in large amounts an irritant, to mucous mem- 
branes, but acts as an efficient carminative and parasiticide in mod- 
erate amounts. As a remedy for tinea tonsurans and pediculi it should 
be applied pure to the part affected and used with caution, for cajuput 
oil is capable of irritating the skin. In diarrhoea of a serous type it 
is of value in the dose of 10 to 20 minims (0.65-1.30). (See Diar- 
rhoea.) Spiritus Cajuputi is official in the B. P. ; dose J to 1 fluid- 
drachm (2.0-4.0). 



CALCIUM. 

Calcium is official in a number of forms, and is to be distinctly 
separated in the mind of the student from calx or lime, which is an 
oxide of calcium. It is never employed as calcium, but as one of its 
salts. These are as follows : Bromide of calcium (Calcii Bromidum, 
U.S.); precipitated carbonate of calcium (Calcii Carbonas Prozeipi- 
tatus, TJ. S. and B. P.) ; chloride of calcium (Calcii Chloridum, TJ. S. 
and B. P.)', hypophosphite of calcium (Calcii Hypophosphis, TJ. S. 
and B. P.) ; and as precipitated phosphate of calcium (Calcii Phosphas 
Pr&cipitatus, TJ. S. ; Calcii Phosphas, B. P.). Calcium sulphate is 
official in the B. P. 

All salts of calcium are incompatible with acids. 

The precipitated carbonate of calcium is used in the treatment of 
serous diarrhoea as an antacid, and as a local protective in cases of 
chapped skin or intertrigo, particularly in young children. When 
given internally the dose is from 10 to 30 grains (0.65-2.0), but by 
far the best method for its administration is in the employment of 
chalk mixture (Mistura Cretce, TJ. S. and B. P.), which contains 
about 30 grains of the chalk to each ounce (2.0-30.0) of liquid. The 
dose of this mixture is from 1 drachm (4.0) for a young child to an 
ounce (30.0) for an adult. In the treatment of cases of serous diarrhoea 
chalk mixture is best given in combination with tincture of kino or 
the compound tincture of catechu and paregoric, in some such form 
as follows : 



128 DRUGS. 

R.— Tr. kino fgj (32.0). 

Tr. catechu comp f^ij (8.0). 

Mistune cretse q. s. ad fgvj (180.0).— M. 

S. — A dessertspoonful (8.0) every three hours till diarrhcea ceases. 

It is to be remembered that the chalk mixture acts very slightly 
as an astringent, and chiefly as an antacid and mechanical agent in 
the alimentary canal. 

Precipitated carbonate of calcium is the slowest antacid which we 
possess, and for this reason is the remedy to be employed in acidity 
of the intestines, as it passes through the stomach to a very great 
extent unchanged. (For the varieties of diarrhoea in which it is to 
be used see article on Diarrhoea.) As an external application it is 
used in sweating of the feet and hands, and sometimes as a dry dress- 
ing to ulcers. It may also be used over burns. 

Calcium chloride, when taken internally in large amount, acts as an 
intense gastro-intestinal irritant, and may produce death by this means. 
It is to be distinctly separated from the chlorinate or chloride of lime, 
with which it is sometimes confused, for the latter is nothing more 
than hydrate of lime or slaked lime, containing 35 per cent, of chlo- 
rine, while chloride of calcium is a hard, vitreous, friable substance, 
giving off no odor of chlorine and utterly different in its use, action, 
and appearance. 

Chloride of calcium is used in medicine by some physicians in the 
treatment of scrofulous enlargements of glands in the neck and else- 
where, and is even said to cause calcification and encysting of tuber- 
cular nodules. In cases where deficient bone-formation is evident it 
often does good, but the other salts of calcium, such as the lactophos- 
phates, are better. In cases where boils mature slowly a poultice 
made by adding a solution of chloride of calcium to the mass may 
be used to hasten suppuration. The dose internally is 5 to 30 
grains (0.32-2.0), best given in a solution made by adding water 
in the proportion of 1 drachm (4.0) to each 5 grains (0.32) of the 
drug. 

Another use of calcium chloride which is one always worthy of trial 
is its employment in the treatment of itching. It should be given in 
the dose of 20 grains (1.3) three times a day to an adult, and may be 
prescribed as follows: 

R.— Calcii chloridi ^ij (8.0). 

Tinct. aurantii flor fgvj (24.0). 

Aqua? chloroformi q. s. ad gvj* (180.0).— M. 

6.— One to '2 tablespoonsfuls (15.-30.) three times a day. 

Smaller doses may be needed if the stomach is irritable. These 
doses usually produce some thirst, and they should be taken about one 
hour after ;i meal. 

Small doses of calcium chloride have also been used to increase the 
coagulability of the blood in "bleeders," and to prevent attacks of 
urticaria byan influence on the blood-plasma. It should not be given 
longer than four days, as after this time it decreases the coagulability 
of the blood. When used the dose should be 15 to 30 grains (1.0-2.0), 



CALCIUM. 129 

followed by 5 grains (0.35) every hour till 5 or 6 doses have been taken. 
Unfortunately, as already stated, it is apt to disorder the stomach. 

The hypophosphite of calcium and the precipitated phosphate of 
calcium are used for the treatment of scrofulosis or strumous states 
and allied conditions, such as rachitis, generally in the form of the 
Syrupus Ht/pophosphitum, U. S., and the Syrupus Calcii Lactophos- 
phatis, U. S. and B. P. 

The large amount of phosphate of calcium in the bones and tissues 
renders it a useful drug when the body is starved of its proper pro- 
portions of salts, and its use has been found, in animals, to cause a 
great increase in bony growth, not only in the earthy, but also in the 
animal, constituents of the osseous tissues. The hypophosphite has 
a similar effect. 

In rickets and in fractures where the bone is slow in uniting, and 
in some cases of phthisis and scrofula, the lactophosphates and hypo- 
phosphites are of service. 

It is worthy of note that these salts are of little value in tubercu- 
losis after it is really well developed. They do good chiefly in the so- 
called pre-tubercular or beginning stages of the disease ; and the good 
effects of the so-called syrups of the hypophosphites depend more upon 
the other ingredients present in them than upon the calcium salts they 
contain. In dental caries, particularly that occurring in nursing women, 
and in the anosmia of this class of patients, they are useful. 

The lactophosphates are better than the hypophosphites, as the 
latter are probably changed into phosphates in the stomach as soon as 
they enter that viscus. The dose of either the lactophosphates or the 
hypophosphites is 10 to 30 grains (0.65-2.0) three times a day, or of 
the syrups just named a teaspoonful to a tablespoonful (4.0-15.0). The 
difference between these salts and phosphorus, both in therapeutical 
effect and in physiological action, is to be clearly borne in mind. The 
lactophosphates and hypophosphites are simply convenient modes of 
administering calcium, potassium, or other substances, while phosphorus 
acts as a stimulant to bone-growth, and not by its deposition in the bone. 
Phosphoric acid does not act any more like phosphorus than does sul- 
phuric acid act like sulphur. 

Sulphate of calcium is not to be confounded with calx sulphurata, 
often wrongly called sulphide of calcium. (See Boils and Calx.) 

Chalk. 

Chalk is a native calcium carbonate, chiefly obtained from shells. 

Prepared chalk {Qreta Prceparata, U. S. and B. P.) is given in the 
dose of 20 to 60 grains (1.3-4.0). Other preparations are compound 
chalk powder {Pulvis Cretce Oompositus, U. $.), composed of prepared 
chalk, acacia, and sugar, and given in the dose of 10 to 60 grains (0.65- 
4.0), and troches of chalk (Trochisci Oretce, U. S.). Mistura Cretan, 
or Chalk Mixture, has been referred to on p. 127. Preparations 
official in the B. P., but not in the U. S. P., are aromatic powder of 
chalk (Pulvis Gretas Aromatieus), dose 10 to 60 grains (0.65-4.0), and 
Pulvis Cretce Aromaticus cum Opio, dose 10 to 60 grains (0.65-4.0). 
9 



130 DRUGS. 



CALUMBA. 



Calumba (Calumbcp Radix, B. P.), Columbo, or Columba, is the 
root of the Jateorhiza Palmata. Its taste is bitter and its odor is 
slightly aromatic. Two alkaloids are found in it, berberine and colum- 
bine, and a third substance known as columbic acid. Calumba is one 
of the purest bitters known, as it does not contain tannic acid. 

Therapeutics. — Calumba is one of the best simple tonics that can 
be used, owing to its lack of astringent effect and to its favorable 
action on mucous membranes. 

In cases of g astro-intestinal atony, particularly that following 
fevers and similar states, calumba will be found of service, and it is 
a valuable remedy in the convalescent stages of summer complaint 
and serous diarrhoeas. The following prescription of Dr. George B. 
Wood is very useful in intestinal atony when it is associated with 
flatulence, although its bulk is disadvantageous and its taste bitter : 

R.— Calumbae pulv. . ' gss (15.0). 

Zingiberis pulv ,^ss (15.0). 

Sennjfifol 3jj (4.0). 

Aquse bullientis Oj (500 cc). — M. 

Ft. in infusum. 
S. — A wineglassful t. i. d. 

Administration. — The fluid extract (Extr actum Calumba? Fluidum, 
U. S.) is given in the dose of 15 to 60 minims (1.0-4.0) ; the tincture 
(Tinctura Calumba?, U. S. and B. P.), dose 1 to 4 fluidrachms (4.0- 
15.0). The dose of the infusion {Infusum Calumba?, B. P.) is J to 1 
fluidounces (15.0-30.0). Liquor Calumbce Concentratus, B. P., is 
given in the dose of \ to 1 drachm (2.0-4.0). 

CALX. 

Calx ( U. S. and B. P.) or Lime, or Oxide of Calcium, is an alka- 
line earth which is incompatible with acids, ammoniacal and metallic 
bases, borates, alkaline carbonates, and astringent vegetable infusions. 
It is prepared by burning pure white marble, oyster-shells, or the purest 
calcium carbonate. 

Therapeutics. — Lime is used for the purpose of acting as an eschar- 
otic, particularly on old ulcers and on hairy gr moths. It is never 
given internally except in the form of the hydrate or slaked lime. 
As an escharotic application lime is used in the official caustic Potassa 
cum Calce, U. 8. When given internally it should always be used 
as Liquor Calais, U. S. and B. P., or lime-water, and under these 
circumstances it acts as an antacid, as an aid to the digestion of milk 
by preventing too rapid and solid coagulation of the casein, and by 
• •veiling an increased gastric secretion. It is also feebly astringent. 
Given to infants and nursing women, it is probably utilized in the 
body in the formation of bone. It is also of value in diabetes, in the 
uric-acid diathesis, and in the excessive nausea and vomiting very 
often seen in adults and children and due to acidity of the stomach. 
Teaspoonful doses of milk and lime-water, equal parts, will often 



CAMPHOR. 131 

be retained by such patients when nothing else will remain in the 
stomach. 

The dose of lime-water is 1 drachm (4.0) to 1 ounce or even 2 
ounces (30.0-60.0). Externally applied, lime-water is of value in 
tinea capitis and similar states, and it is a good application in burns, 
after it is mixed with equal parts of linseed or olive oil, forming the 
Linimentum Calcis, U. S. and B. P., or carron oil. As a local appli- 
cation in membranous croup and diphtheria lime-water has a high 
reputation, and is believed to dissolve the membrane, but it does not 
compare in usefulness with peroxide of hydrogen. It may be used as 
a spray or by means of a swab. 

Liquor Calcis, or lime-water, is to be made by adding a piece of 
unslaked lime as large as a walnut to 2 quarts of boiled and filtered 
water in an earthen jar ; after stirring it thoroughly allow it to settle, 
and pour off the clear liquid into a bottle. More water may then be 
added to the lime until it is all used. 

Sulphurated lime (Calx Sulphur ata, U. S. and B. P.) is useful to 
check inflammation and hasten suppuration ; the dose is y 1 ^ to \ of a 
grain (0.006-0.05). It is of great value in acne pustulosa and all 
forms of suppuration in the skin. Where sulphurate of lime is not 
obtainable and successive crops of boils constantly appear, it is often 
possible to relieve the patient by baking egg-shells in an oven, pow- 
dering them, and then letting the patient eat 1 drachm (4.0) or more 
of the powder each day. 

The preparations of the B. P. that are not official in the IT. S. are 
the saccharated solution of lime (Liquor Calcis Saccharatus), dose 15 
to 60 minims (1.0-4.0), and slaked lime (Calcii Hydras), used in mak- 
ing different preparations. 

(For Calx Chlorata, see Chlorinated Lime.) 



CAMPHOR. 

Camphor (Camphor a, IT. S. and B. P.) is derived from the Gin- 
namomum Camphora, which grows chiefly in China and Japan. The 
camphor used in the drug-stores is in reality refined camphor, and is 
so obtained by repeated sublimation. It is a volatile, irritant stear- 
opten, producing a burning taste and possessing a peculiar odor, 
soluble in 1000 parts of cold water and in 1 part of strong alcohol. 
Camphor is so volatile that if allowed to remain exposed to the air 
for any length of time it rapidly loses its bulk and eventually disap- 
pears. It is an exceedingly combustible substance, burning with a 
flame and much smoke. It may be white or pinkish in color. 

Physiological Action. — If taken in large amount, camphor pro- 
duces epileptiform convulsions, preceded by vertigo, roaring in the 
ears, and delirium. The pulse soon becomes rapid, feeble, and run- 
ning, and the skin livid, cold, and covered with sweat. Great heat 
and burning may be felt in the belly, and, if the poisoning be slow, 
evidences of gastro-intestinal and renal inflammation ensue. In small 
doses it acts as a stimulant and adds a sensation of warmth to the 



132 DRUGS. 

stomach, while the pulse ma} 7 become more rapid and stronger under 
its influence. At the same time there is a sedation of the. nervous 
system and a general feeling of contentment. In large medicinal 
dose camphor is thought by some to act as a sexual stimulant, and by 
others as a sexual sedative. The stimulant effect is probably only 
produced by doses large enough to produce irritation of the genito- 
urinary tract. The convulsions following poisonous doses are due to the 
action of the drug on the brain. The drug, although largely destro} 7 ed 
in the body, is chiefly eliminated by the kidneys as campho-glycuric 
acid, and also escapes by the breath and the perspiration. 

Therapeutics. — Internal Use. — Camphor is employed for the 
purpose of acting as a nervous sedative and antispasmodic in the treat- 
ment of nervous women and children, and as a carminative in persons 
who suffer from intestinal flatulence. It is of value is nervous dys- 
menorrhea and headache, and is best combined with one of the new 
analgesics, such as antipyrin and acetanilid given in tablet-form. As 
it is virtually a volatile oil so far as its physiological action is con- 
cerned, it will be found useful in cholera and in cholera morbus and 
all forms of serous diarrhea, but rarely in mucous diarrhoea. (See 
Diarrhoea.) In chordee, combined with bromides and similar de- 
pressants to the spinal cord, camphor is of great service in some 
cases, particularly late in the disease. In adynamic fevers it has 
been used as a diffusible stimulant by Graves and others with great 
success. Camphor is a very useful remedy in cases of sudden nervous 
depression coming on in the course of acute or prolonged exhausting 
diseases. It may be given by the mouth or, if the emergency is a press- 
ing one, by hypodermic injection. Under these circumstances it is best 
given in the form of camphorated oil in the strength of 1 part of cam- 
phor to 9 of sweet oil, which last should be perfectly sterile. The dose 
of this solution is 15 minims (1.0). When used in the nervous depres- 
sion of phthisis, Alexander asserts that its continuous injection 
may result in cumulative action and develop the symptoms of mild 
camphor poisoning. In hiccough it is of great service, and in 
cardiac palpitation due to functional irritability it is found to be 
of value. In capillary bronchitis and catarrh of the air-passages it 
will be found useful in old or atonic cases. In chronic nasal 
catarrh spirits of camphor when inhaled from the neck of a vial 
gives off enough of the drug to start up secretion and tone up the 
parts. It is also of value as a mouth-wash in persons who have foetid 
breath. 

Camphor may be inhaled or taken internally in cases of coll in 
the head, in the early stages, with great relief and a decided influence 
in aborting the attack. The following formula may be employed: 

R. — Camphone gr. ij (0.12). 

Ext. belladonna? i\ nijss (0.09). 

Quininae ralph gr. ij (0.12).— M. 

Ft tabellse No. x. 
S. < )nc every hour for four or five doses. 

After the attack is in full force this is useless, but used early it will 



CAMPHOR MONOBROMATE. 133 

decrease the frontal headache and the sneezing and running at the 
nose. In coryza from unknown causes with much lachrymation and 
incessant sneezing, camphor will be found of benefit. It may be snuffed 
up the nostril in a fine powder, or powdered camphor may be put in boil- 
ing water and the fumes inhaled. The spirit may also be inhaled from a 
handkerchief. 

External Use. — Externally camphor may be used as a stimulant 
to indolent sores and as a useful addition in small amount to the pre- 
cipitated carbonate of calcium as a dusting-power in intertrigo. In 
the form of a liniment camphor is used over inflamed joints from 
sprains or rheumatism, and in myalgia and neuralgia to relieve the 
pain and stiffness. 

Camphorated alcohol, spirit of camphor, is a useful application for 
abortive purposes when used over boils in their early stages, if repeated 
two or three times a day for a few moments at a time. Following these 
applications, the .skin should be dried and camphorated oil applied. 
Ringer and Tilt both recommend that Eau de Cologne, saturated with 
camphor, be rubbed into the head in the droivsiness and headache of 
the menopause, and a lotion of equal parts of aqua ammonia and spirit 
of camphor dabbed on the painful or hypersesthesic spots at the top of 
the head, so commonly felt by nervous women at the change of life or 
during menstruation, will be found to give relief. 

Administration. — Camphor is used internally in the form of the 
camphor-water {Aqua Camphorw, TJ. S. and B. P.), dose J to 2 fluid- 
ounces (16.-64.) ; the spirit of camphor (Spiritus Camphoraz, TJ. S. 
and B. P.), dose \ a fluidrachm (2.0), or in the form of the camphor 
itself, in pill, in the dose of 1 to 3 grains (0.05-0.15) in each pill. 

The best preparation for internal use is the spirit, or the gum cam- 
phor itself may be given. 

For external use we have, official, the camphor liniment (Lini- 
mentum Camphor ce, TJ. S. and B. P.) and the soap liniment, or Lini- 
mentum Saponis, TJ. S. and B. P., which is the milder of the two. 
Ceratum Camphors is also official. A compound tincture of camphor 
(Tinctura Camphorm Composita), composed of opium, benzoic acid, 
camphor, and oil of anise, is official in the B. P., dose 15 minims 
to 1 fluidrachm (1.0-4.0). This preparation is practically equivalent 
to "paregoric." Linimentum Camphorce Ammoniatum, B. P., is 
composed of camphor, rectified spirit, and stronger ammonia. 

CAMPHOR MONOBROMATE. 

Monobromated Camphor {Camphor a monobromata, TJ. S.) is made 
by heating together in a sealed tube camphor and bromine. It occurs 
in colorless crystals or scales, and has a mild taste resembling camphor. 
It is almost entirely insoluble in water, but is freely soluble in alcohol, 
ether, and chloroform. 

Physiological Action. — Monobromated camphor possesses powers 
partaking of the bromides and of camphor. In the frog it causes loss 
of reflex action, motor palsy and death by respiratory failure, and in 
warm-blooded animals violent convulsions, Cheyne-Stokes respirations, 



134 DRUGS. 

muscular tremblings, and weakness. The pulse is at first more rapid 
than normal, then slow and weak, death coming in coma or during 
the convulsions. 

Therapeutics. — Monobromated camphor will generally be found most 
useful for pain when combined with other drugs, particularly in lum- 
bago, or the pain due to nervous disturbances. If used in hysterical 
females, it will often produce sleep, and is of value to those who are 
addicted to the alcohol-habit, as it acts as a hypnotic and warms 
the stomach. Like camphor itself, it is a gastric irritant, and 
should not be employed where gastritis exists. It has been used in 
spermatorrhoea with great success, and in delirium tremens has been 
found of benefit in cases where the gastric mucous membrane is 
depressed and the nervous twitchings are troublesome. In whoop- 
ing-cough it may be tried, and it has even been used in chorea, epi- 
lepsy, and petit mal. In the nervous depression and pains of epi- 
demic influenza monobromated camphor has been largely used. (See 
Acetanilid.) 

Administration. — This drug should never be used hypodermically, 
as it is too irritating, but administered in the dose of 5 grains (0.32) 
three times a day in pill, or in an emulsion made by dissolving it in 
six times its weight of expressed oil of almonds and then forming an 
emulsion with gum arabic water in the usual manner. 

CAMPHORIC ACID. 

Camphoric Acid is made by the oxidation of camphor through the 
influence of acids, and is the best remedy for the night-siveats of 
phthisis. In a large number of cases suffering from night-sweats the 
author has found this drug to act very favorably indeed where other 
remedies failed, and he has never seen it produce any disagreeable 
symptoms. 

It may be resorted to in the dose of from 20 to 30 grains (1.3-2.0), 
taken an hour or two before the sweat is expected. In very obstinate 
cases as much as 60 grains (4.0) should be given, but under these cir- 
cumstances it should be used in two separate doses of 30 grains (2.0) 
each, two hours apart, in order to avoid irritating the stomach. It is 
best given in capsule or cachet, as it is insoluble in water. In other 
in-iances camphoric acid may be given in the following formula: 

\{. — Acid, camphoric ^iv (15.0). 

Alcohol f|ij (60.0). 

Mucilag. acaciae fgiij (90.0). 

Syr. aurantii corticis q. s. ad f'^vj (180.0).— M. 

8.— Dessertspoonful (8.0) to a tablespoonful (16.0) one hour before sweat is 
expected. 

It is worthy of note that camphoric acid is possessed of little power, 
in the writer's experience, in cases of bromidrosis. 

CANNABIS INDICA. 

Indian Hemp (Cannabis Indira, U. S. and B. P.) is the flowering 
\<>\>- of tli.- female plant of Cannabis sativa. It is to be distinctly 



CANNABIS IN DIC A. 135 

separated from the so-called American, American-Indian, or Canada 
hemp, or Apocynum Cannabinum, which is, in full doses, an intense 
irritant and drastic. 

The selection of this drug is attended with peculiar difficulties be- 
cause of the fact that only the non-fertilized female flower-spikes are 
possessed of therapeutic activity, the male spikes and female flower- 
tops which are bearing seed being inert. At the same time the three 
varieties resemble one another so closely that when crushed and inti- 
mately mixed in a bale it is practically impossible for even a drug expert 
to distinguish the active from the inert. 

Physiological Action. — Given in full dose to man, this drug causes 
exhilaration and attacks of incessant laughter arising from the slightest 
cause, the person seeming convulsed with merriment ; in other cases 
the sensations are disagreeable, and even death may seem imminent to 
the deranged mind. Sometimes the sensation of very full breathing 
comes on, and the patient thinks he is about to burst with the inflation 
of his lungs. After this deep sleep appears, lasting for many hours, 
even as much as fourteen or fifteen, without any intervals of wake- 
fulness. One of the most constant and pressing symptoms in poison- 
ing in man is the marked sensation of prolongation of time, so that 
minutes seem like hours, and, in addition to this, a peculiar separation 
of the mental powers occurs, during which both hemispheres of the 
brain seem to think differently on the same subject. If the dose be 
very large, the respirations are slowed very considerably, but no death 
from the use of cannabis indica by man is on record, and enormous 
amounts have been given to the lower animals without causing a lethal 
effect. 1 Applied to mucous membrane, it acts as a very severe irri- 
tant, and then as a local anaesthetic, but the primary effect is so 
powerful as to prevent its application to mucous membranes for the 
relief of pain. 

Therapeutics. — Cannabis indica is one of the best additions to 
cough mixtures that we possess, as it quiets the tickling in the throat, 
and yet does not constipate or depress the system as does morphine. 
In advanced phthisis it is justifiable to keep the patient constantly in a 
state of quiet comfort by its use. For the relief of pain, particularly that 
depending on nerve-disturbance, hemp is very valuable. Before the 
introduction of antipyrin and its congeners, tincture of gelsemium and 
the tincture or extract of cannabis indica were our best remedies in 
the treatment of migraine. The gelsemium in such cases should be 
given in full dose, 20 drops (1.3) of the tincture, and be followed by 
10 to 20 drops (0.65-1.3) of the fluid extract of cannabis indica, it 
being known that the sample about to be used is active.- After this 
dose of gelsemium the patient should be carefully watched, lest he 
suffer from an excessive influence of the drug, as such an amount 
may produce great depression in susceptible persons. In true migraine 
with hemianopsia this treatment is often most effectual in aborting 
the attack. The prevention of further attacks is to be attained by 

1 The author has injected as much as 5 drachms of a fluid extract, active in the 
dose of 10 minims to man, into the jugular vein of a small dog without producing 
death for many hours. 



136 DRUGS. 

the use of smaller amounts of the cannabis indica during the inter- 
vals, the gelsemium only being used at the onset of the symptoms. In 
paralysis agitans cannabis indica may be used to quiet the tremors, 
and in spasm of the bladder, due to cystitis or nervousness, it often 
gives great relief. In sexual impotence, not dependent upon organic 
disease, it is said to be of value combined with strychnine or nux 
vomica and ergot. 

In headaches at the menopause cannabis indica is useful, and if the 
headaches are associated with constipation and anaemia, iron and aloes 
should be given simultaneously. Where headaches are due to retinal 
asthenopia a very useful prescription, according to de Schweinitz, is 
as follows : 

R. — Tr. nucis vomicae f^ij (8.0). 

Tr. cannabis indicse . . f^ij (8.0). — M. 

S. — 15 drops (1.0), in water, twice or thrice a day. 

The following prescription has been found to be very efficient in the 
hands of the author in treating gastralgia and other forms of abdomi- 
nal pain : 

R .— Tr. capsici f Sfij (8.0). 

Tr. cannabis ind f'^ss (15.0). 

Tr. opii deodorati ix] (30.0). 

Spt. chloroformi fgj (30.0). 

Spt.lavandul.comp q. s. ad f^iv (120.0).— M. 

S. — Teaspoonful (4.0) every hour until pain is relieved. 

In cases of uterine subinvolution, chronic inflammation, and irrita- 
tion cannabis indica is of great value, and it has been found of service 
in metrorrhagia and nervous and spasmodic dysmenorrhoea. Not only 
• Iocs it relieve the pain, but it seems to act favorably upon the mus- 
cular fibres of the uterus. 

In acute and chronic Bright' s disease cannabis indica often allays 
the painful sensations over the renal region, and has been recom- 
mended by some writers in the cases in which bloody urine is present. 
In gonorrhoea it is said to decrease the discharge and prevent chordee, 
and it has supplanted the use of copaiba and cubebs in some practi- 
tioners' hands. It should not be used in the early stages of gonor- 
rhoea, but in the later or subacute stages. There is some foundation 
for the belief that in small doses it acts as a sexual stimulant. 

The advantages possessed by cannabis indica are that it does not 
constipate nor cause after-depression and nausea.' On the contrary, 
there is often an increase rather than a decrease of the appetite under 
its influence. In the Anglo-Saxon race the cannabis indica habit is 
practically unknown, but in the East Indies when used to excess it 
sometimes causes maniacal insanity, from which the patient nearly 
always recovers after some days, weeks, or months. 

Administration. — The employment of this most valuable remedy is 
handicapped by its frequent lack of power — a fault which is largely 
dependent upon reasons already given. Only a preparation which has 
1m.ii physiologically tested should be used. The drug as prepared by 
Parke, Davis & Co. has proved efficacious in the author's hands for a 
number of years. The physician should always employ some prepara- 



CANTHARIS. 137 

tion known by him to be active by personal trial before condemning 
the drug as a failure in a given case. 

The dose of the solid extract (Extractum Cannabis Indicw, IT. S. 
and B. P.) is from \ to J grain (0.015-0.03), that of the fluid extract 
(Extr actum Cannabis fndicce Fluidum, U. S.) from 4 to 20 minims 
(0.3-1.3), and that of the tincture {Tinctura Cannabis Indicce, U. S. 
and B. P.) from 15 minims to 1 drachm (1.0-4.0). 



CANTHARIS. 

Cantharis (U. S. and B. P.), or " Spanish Fly," is really a beetle, 
known as the Cantharis vesicatoria, and as such appears with irides- 
cent coverings or wing-sheaths of a bluish or greenish hue. The 
insects come chiefly from Spain, Italy, and Sicily, and from the south- 
ern parts of Russia. Those from Russia are supposed to be the best. 
According to Leidy, the vesicating substance is in the blood, the eggs, 
and the secretions of the generative apparatus. The blistering sub- 
stance contains cantharidin as an active principle, but cantharidin is 
not medicinally employed. 

Physiological Action. — Locally applied to the skin, cantharides causes 
irritation and finally vesication. The blister produced may be quite large, 
and enough of the drug may be absorbed to cause fever and nervous ex- 
citement. The ingestion of a moderate dose of cantharides produces a 
sensation of warmth in the stomach and slight stimulation of the genito- 
urinary system, particularly the kidneys and urinary tracts. Large 
amounts produce great pain in the lumbar region, burning in the blad- 
der and along the entire urethra, priapism, agonizing vesical tenesmus, 
widespread acute nephritis, bloody urine, which is scanty at first, and 
finally suppressed, with great irritation of the external openings of the 
genito-urinary apparatus. The inflammatory changes which are pro- 
duced may cause sloughing of the penis or of the labia in the female. 

Violent gastro-enteritis is nearly always a pressing condition. A 
diagnostic sign of cantharidal poisoning, when the beetles have been 
swallowed, is the appearance of pieces of the iridescent wing-sheaths 
or coats in the vomit. Thirst is always a prominent symptom of 
poisoning by cantharides. 

Therapeutics. — Cantharides are employed internally and externally. 
When given by the mouth the tincture is used as a uterine stimulant, 
to affect the uterine mucous membrane and relieve amenorrhea in 
cases in which atony and depression are the cause of the suppression. 
Some persons teach that the tincture of cantharides is a valuable 
remedy in small doses in the second stage of acute desquamative 
nephritis, but in the instances where the writer has seen it used it 
has made matters much worse, although it is supposed to decrease the 
quantity of the albumin and blood. In the later stages, where the kid- 
neys are relaxed and torpid or where albuminuria comes on on the 
slightest exertion, tincture of cantharides in the dose of 1 minim (0.05) 
three times a day is of great service. 

In cases of chronic parenchymatous nephritis, particularly where 



138 DRUGS. 

alcoholism is the cause of the disease and the kidneys are inactive, can- 
tharidal tincture is very useful. In pyelitis and in chronic cystitis it is 
of service, and it has been recommended very highly in drop doses in 
irritability of the bladder in women and children. In these cases the 
bladder must not be inflamed, but irritable from depression. The use 
of cantharides is of value in incontinence of urine of a minor degree, 
as that occurring in some elderly or nervous females when coughing, 
sneezing, or laughing, and will often given relief after many years of 
suffering. In chordee, in the dose of 1 minim (0.05) twice or thrice 
daily, it is sometimes of service. For impotence depending upon sexual 
excess Ringer asserts that the use of 10 to 15 minims (0.65-1.0) of 
the tincture of cantharides, with full doses of the tincture of the chlo- 
ride of iron and dux vomica, will often relieve the patient and enable 
him to beget children. This dose of cantharides must be given 
with caution. The drug has no true aphrodisiac influence except when 
given in almost toxic dose. In gleet of a very chronic type and in 
prostatorrhoea it is of service. Dermatologists have used cantharides 
internally as a remedy in psoriasis, eczema, lichen, and prurigo, with 
asserted great success. The dose should not be large enough to irritate 
the stomach or kidneys. 

Externally, cantharides are used in the production of blisters for 
the purpose of causing the absorption of effusions or as a counter-irritant 
of some severity in cases of deep-seated inflammations. (See Counter- 
irritation.) Care should be taken that a sufficient amount of the drug is 
not absorbed to cause strangury and renal irritation. In renal con- 
gestions and inflammations the use of cantharides as a counter-irritant 
is often con train dicated because of this danger. Huchard and others 
have reported cases in which, without any previous disease of the 
kidney, a cantharidal blister has produced violent acute nephritis, with 
uremia therefrom. In the proportion of 1 minim (0.05) of the tincture 
of cantharides to 40 (2.6) of water it is said to be a very good appli- 
cation for hums, but how it acts is not known. 

Administration. — The dose of the tincture (Tinctura Cantharidis, 
U. S. and B. P.) is from 1 to 10 minims (0.05-0.60), and it is the 
only preparation used internally. The cerate {Ceratum Cantharidis, 
U. S.) is used, spread upon a rag, to produce a blister, and the cerate 
of the extract, which is no longer official, is used for the same pur- 
poses and in the same manner. The cantharidal collodion (Collodium 
Oantkaridatum, U. S.. Collodium Vesicans, B. P.) is a method of 
applying the blister which is most cleanly, but there is more danger 
of absorption of the drug if it is used. The collodion acts as a pro- 
tective to the part. Liquor Pjoispasticus, B. P., is employed as a 
counter-irritant. 

" Warming plaster" (JEmplastrum Pieis Cantharidatum, U. S.) is 
a mild counter-irritant plaster to be employee! where a blister is thought 
to be too Bevere. The preparations of the B. P., other than those 
named, are Emplastrum Cantharidis and Unguentum Cantharidis. 

The unofficial plasters of cantharides made by several firms are 
the best preparations to use for the production of a blister. In order 
to obtain ;i perfect effect the skin should be washed thoroughly with 



CAPSICUM. 139 

soap and water and dried with a towel, which should be rough enough 
to produce reddening of the cuticle. After this the skin should be wet 
with vinegar, and while wet the blister is to be applied. 

CAPSICUM. 

Capsicum, U. S., Capsici Fructus, B. P., or Cayenne Pepper, is 
the fruit of Capsicum fastigiatum or minimum, a native of tropical 
Africa and of Central America. It occurs in long, ovoid pods, which, 
when ripe, are scarlet red and possess a very hot, burning taste. The 
active principle is capsicine, which is a dark -reddish liquid, which is 
a volatile alkaloid. 

Physiological Action. — Locally applied to the skin or mucous 
membranes, capsicum causes great redness, and finally, in the case 
of mucous membranes, vesication. The alkaloid will also produce 
these changes in the skin. When used internally for any length of 
time in excess capsicum will cause a chronic or subacute gastritis 
with pain and discomfort over the liver and stomach. If single large 
doses are used renal irritation and inflammation ensue, with strangury 
and high-colored urine. Taken internally, capsicum is said to act as 
a circulatory stimulant. 

Therapeutics. — In cases of atony of the stomach due to general 
debility, errors in diet, and alcoholism of the chronic type capsicum 
is one of the best remedies we have. When the patient is suffering 
from. acute alcoholism the gastric mucous membrane is often too much 
irritated to permit of its use, but after the lapse of some days it may 
be found of benefit for the purpose of increasing the digestion. As a 
remedy for subacute alcoholism it is quite useful, since by its stimu- 
lating effect and hot sensation it often satisfies, at least to some degree, 
the craving for alcohol. Under these circumstances it should be used in 
the dose of 5 to 10 minims (0.30-0.65) of the tincture every four or five 
hours, or as the oleoresin in pill in the dose of J to 1 grain (0.03—0.05). 
The following prescription has been found of great service in these 
cases : 

R.— Tr. capsici f^ijss (10.0). 

Tr. opii deodorat £?ij (8.0). 

Spt. aether, nitrosi f^iv (15.0). 

Tr. lavandulse comp q. s. ad fgiv (120.0).— M. 

S. — Dessertspoonful (8.0) every four or five hours. 

In the flatulent colic of old persons and young adults capsicum 
will be found not only to act as a carminative, but also to prevent the 
development of the gas. In low fevers it has been used as a diffusible 
stimulant, but it is of doubtful value. It is rather in the anorexia 
of convalescence that capsicum acts most favorably. In chronic 
nephritis it is of considerable service, and it tends to check albumi- 
nuria, but it is only to be used in the chronic forms and stages of 
renal disease or in the treatment of functional torpidity of the kid- 
ney. The tincture is to be given under these circumstances in the 
dose of 20 minims (1.3) or less, but in some cases which are very 
chronic as much as 40 minims (2.65) may be used. In sore throat and 



140 DRUGS. 

simple tonsillitis the tincture of capsicum and glycerin, half and half, 
form a very useful local application applied by means of a swab. 
The same preparation may be used as a gargle for relaxed uvula and 
sore throat. 

Capsicum may be used as a gastro-intestinal stimulant to aid in the 
absorption of other drugs. Applied externally, capsicum acts as a 
counter-irritant, producing redness of the skin, but not a blister in the 
ordinary individual. It is one of the best moderate counter-irritants 
which can be used, and it may be employed by saturating blotting- 
paper, time and time again, in the tincture of capsicum, allowing it to 
dry between each dip. This paper should finally be placed when warm 
and wet over the part, and held closely to the skin by a compress. 
Capsicum plaster (Emplastrum Capsici, TJ. S.) is useful in lumbago 
and rheumatism when placed over the affected muscles, and in headache 
when applied to the nape of the neck. The tincture is sometimes 
painted over chilblains which are unbroken.* The following method, 
given by Ringer from Rheims, is very efficacious in this annoying 
affection : 

" Make a strong tincture of capsicum-pods by steeping them for 
several days in a warm place in twice their weight of rectified spirits 
of wine. Dissolve gum arabic in water to about the consistence of 
treacle. Add to this an equal quantity of the tincture, stirring 
together with a small brash or a large camel's-hair pencil until they 
are well incorporated. The mixture will be cloudy and opaque. 
Take sheets of silk or tissue-paper ; give them, with the brush, a coat 
of the mixture; let them dry, and then give another. Let that dry, 
and if the surface is shining, there is enough of the peppered gum ; 
if not, give a third coat. This paper should be applied in the same 
way as court-plaster to chilblains that are not broken and burns that 
are not blistered, and it will speedily relieve the itching and pain. 
It acts likes a charm and effects a rapid cure. The same is true of 
discolored bruises. It likewise allays rheumatic pains in the joints." 

The dose of capsicum is 1 to 2 grains (0.05-0.1) in powder, on 
food or in pill. The dose of the tincture of capsicum (Tinctura Cap- 
sici, TJ. S. and B. P.) is 10 to 20 minims (0.05-1.3), and of the oleo- 
resin {Oleoresina Capsici, TJ. S.) \ to \ minim (0.015-0.03). The 
dose of the fluid extract {Extr actum Capsici Fluidum, TJ. S.) is 1 to 
3 minims (0.05-0.15). The plaster (Emplastrum Capsici) is useful 
for external applications. An ointment (TJnguentum Capsici) is 
official in the li. P. 

CARBOLIC ACID. 

Carbolic Acid (Aeidum Carbolieum, TJ. S. and B. P.) is also 
known as Phenol. Phenylic Alcohol, and Phenic Acid. Not only is 
it an acid, bill in addition it is an alcohol of the peculiar group 
known as the pln-nols. which are derived from coal-tar by a process 
of distillation. Its acidity is, however, very feeble. 

Carbolic acid is sold in several grades, No. 1 being the purest. 
Both No*. 1 and -1 are crystalline, while Nos. 3, 4, and 5 are impure. 



CARBOLIC ACID. 141 

because of the presence of cresylic acid and other foreign substances. 
Only No. 1 should be ordered when carbolic acid is to be given by 
the mouth. 

It has a peculiar characteristic odor, and varies in color according 
to its method of preparation and purity. It is soluble in 20 per cent, 
of water, but it is liquefied by the addition of 6 per cent, of water. 
Carbolic acid should be kept in dark amber-colored, well-stoppered 
bottles. 

If the crystals be exposed to the air, they undergo liquefaction, 
and in consequence the purest carbolic acid is usually prescribed in 
minim doses rather than in grains. It is soluble in alcohol, ether, 
chloroform, glycerin, and most oils. It unites with alkaline bases to 
form salts, carbolates ; but these are very readily decomposed even by 
the feeblest acids, such as carbonic acid. 

Physiological Action.— Locally applied to the skin, carbolic acid 
produces at first a burning sensation, accompanied by a diffuse redden- 
ing of the surface. If the solution be strong, the part at once becomes 
temporarily painful, then bleached and numb, so that tactile sensibility 
is destroyed. Applied to mucous membranes, it causes similar changes, 
but to a more marked degree, and may even act as a moderately severe 
caustic of a superficial type. Owing to the coagulation of albumin 
produced when it is applied, it cannot cauterize the tissues very deeply. 

Nervous System. — Carbolic acid acts as a depressant and para- 
lyzant to the peripheral sensory nerves when locally applied. Upon 
the higher centres in the brain the acid produces a condition of 
depression and stupor. 

The convulsions which sometimes occur after toxic doses have been 
taken are spinal in origin, as they occur after section of the spinal 
cord. The motor nerves escape almost untouched, as do also the 
muscles. 

Circulation. — Upon the circulation in the higher animals the drug 
exercises a distinct depressant influence, stopping the heart in diastole 
in lethal dose, and paralyzing the vasomotor centre even before the car- 
diac muscle is affected. These changes follow only lethal doses. Small 
medicinal doses have no effect of any moment upon the circulation. 

Respiration. — After large doses the breathing becomes more rapid 
and full. These changes, according to Salkowski and others, are due to 
stimulation of the respiratory centres and the peripheral vagi. Lethal 
doses almost invariably kill by failure of respiration due to depression 
of the respiratory centres. 

Temperature. — Carbolic acid acts as a feeble' depressant to nor- 
mal bodily temperature even when given in medicinal dose, and also de- 
creases the bodily heat in fever. It lowers fever by diminishing heat- 
production and increasing heat-dissipation. This antipyretic power is 
hardly sufficient to permit of its use in disease for this purpose. 

Kidneys and Elimination. — When carbolic acid is given in over- 
dose the kidneys may become so irritated that total urinary suppression 
may occur. When taken in large quantity it causes the urine to become 
brownish-black. This discoloration is due to an educt of carbolic acid 
which is not yet isolated, unless it be hydrochinon. Carbolic acid is 



142 DBUGS. 

eliminated in the urine as a sulphocarbolate of sodium and potassium 
and as glyco-uronic acid and hydrochinon. Part of it is burnt up in 
the body. , 

It is to be distinctly understood that the dark urine of carbolic- 
acid poisoning is not due to the presence of blood or any of its 
educts. 

Poisoning, Prolonged and Acute. — As the changes produced in the 
tissues of the body by acute and chronic poisoning by carbolic acid are 
identical, they may be considered together. 

Carbolic acid is one of the most deadly and rapidly-acting poisons 
known, although this fact does not seem to be generally recognized. If 
a large lethal dose be swallowed by a man, he may drop dead from its 
effects before he can go more than a few feet from the spot where he stood 
when drinking the drug, or he may live a few hours. In cases where 
death has occurred suddenly from taking this acid the direct cause has 
been failure of respiration. If the patient does not die at once, all the 
evidences of gastro-enteritis come on. Violent vomiting and purging 
may ensue, and burning pain in the entire abdomen is a prominent 
symptom. The skin is wet with sweat, the face pinched and anxious. 
Collapse, with a thready, imperceptible pulse and extreme dyspnoea, 
may be present. The mouth and lips may not smell of the drug, but 
the mucous membrane will be seen to be corrugated and stained black 
if impure acid has been taken, or be whitish if the pure drug has been 
used. The eschar on the mucous membrane is a peculiar one, and is 
pathognomonic of the poison, having a white centre surrounded by a 
reddened and inflamed zone, the centre sometimes becoming dark brown 
or black. The post-mortem will show these spots in the oesophagus 
and stomach, and even in the intestines. All the internal organs, as 
the brain, kidneys, liver, and spleen, will be found filled with dark 
grumous blood, and on opening the body the strong odor of the acid 
will be perceived. A peculiar croupous exudate is sometimes found 
in the bronchial tubes, and fatty degeneration of a more or less wide- 
spread type often follows carbolic acid poisoning. Langerhans has 
noted that in some of these cases evidences of croupous pneumonia 
exist. A very common symptom is hoarseness of the voice, due to an 
effect on the larynx after the drug is absorbed, and not from its local 
influence. 

A large number of cases are on record in which subacute carbolic 
acid poisoning has been produced by its absorption from surgical 
dressings. The earliest signs of such an accident are the darkened, 
smoky hue of the urine and a slight nervous unrest or cerebral dis- 
turbance. Very often pain in the lumbar region indicates kidney strain 
and irritation. The dressings should be, of course, at once removed. 

Treatment of Poisoning. — The chemical antidote to carbolic 
acid is any soluble sulphate, such as Epsom or Glauber salts, which 
form insoluble sulpho-carbolates, and which are preferable to other 
Soluble sulphates in that they also act as purgatives if freely used, and 
so wash out the bowel. The further treatment consists in the admin- 
istration of warm mucilaginous drinks, hot applications to the extremi- 
ties, the hypodermic injection of cardiac and respiratory stimulants, 



CARBOLIC ACID. 143 

such as digitalis and strychnine, morphine to relieve pain, and the 
use of counter-irritation over the abdomen. Emetics and the stomach- 
pump should be used if possible, but the former are generally useless 
because of the state of the stomach. 

When carbolic acid has been spilled on' the hands its effects can 
be overcome if the hands are immersed at once in absolute alcohol. 
There is no satisfactory explanation of this very extraordinary effect. 
Alcohol may also be used internally as an antidote ; but as it cannot 
be taken in concentrated form, its internal use is not of much value in 
this condition. 

Therapeutics. — Internally carbolic acid is little used, but, neverthe- 
less, has a very favorable effect in certain states. In nervous vomiting 
or in that due to gastric irritation the drug does good in J to 2 minim 
(0.03-0.12) doses by depressing the sensory nerves in the stomach. 

In diarrhoea depending upon fermentation from 2 to 4 minims 
(0.10-0.20) of the acid do great good, particularly if combined with 
10 to 20 grains (0.65-1.30) of bismuth administered in powder or 
capsule. 

In gangrene and tuberculosis of the lung a spray of the acid in 
water in the strength of 5 to 15 minims (0.3-1.0) to the ounce (30.0) 
may do some good, and at least control the cough and relieve the irri- 
tation and tickling in the throat} (See Part III., Inhalations.) Creosote 
is, however, generally preferred in these conditions at the present time. 
In diphtheria, ulcerated sore throat, and even in ordinary stomatitis, 
carbolic acid will be found of value when used in a spray or mouth- 
wash in the proportion of 1 part to 75 parts of water ; and in ordi- 
nary sore throat or that due to sepsis in the strength of 1 part to 100 
of water it will be found, when applied on a swab or by a gargle, to 
relieve the pain and inflammation. In the treatment of burns carbol- 
ized sweet oil in the proportion of 1 drachm (4.0) of the acid to each 
6 ounces (180.0) makes one of the best dressings that can be used. 
By means of the local anaesthesia produced by the acid, minor opera- 
tions, such as eversion of an ingrowing toe-nail or opening a felon, 
may be performed by applying the pure acid by means of a brush to 
the line of the incision. Carbolic acid may be used as a lotion in the 
itching of jaundice in the proportion of 10 grains (0.65) of the acid 
to 2 drachms (8.0) of glycerin and 2 drachms (8.0) of water, or, 
better still, 4 drachms (15.0) of sweet oil. In the form of an ointment 
carbolic acid may be used in the strength of 10 minims to the ounce 
(0.65 : 30.0) of a simple cerate, particularly in cases of subacute eczema 
where there is a great amount of weeping. In cases of eczema with 
much itching, and in pruritus and lichen planus, the following oint- 
ment is useful : 

R.— Menthol gr. v (0.32). 

Acid, carbolic gr. x (0.65). 

Urig. aquae rosse Jj (30.0). — M. 

S. — Apply locally. 

lr The spray must be a very fine one, or it will not carry the drug far enough down 
into the lungs to do any good. 



144 DRUGS. 

In enlarged glands which have not yet gone on to suppuration 
intraglandular injections of carbolic acid by means of a hypodermic 
needle are of value in a large number of cases, the solution used being 
no -weaker or stronger than 2 per cent. ; 5 to 10 minims (0.30-0.15) 
of this solution are sufficient for each gland. In the treatment of 
buboes 10 minims (0.6) of a solution of 8 grains (0.5) to the ounce 
(30.0) may be injected into the swelling, the skin being first 
benumbed by an ether spray. This is a most successful treatment. 
The same treatment may be applied in chronic synovitis and repeated 
every three days, and boils and carbuncles may also be so treated with 
great success if the measure be used early enough to abort the trouble. 

Carbolic acid is rarely used directly over ivounds in dressings at 
present unless the dressing be one of carbolized oil. Other drugs 
or rigid asepsis have supplanted it when used in this way, but surgeons 
have returned to its employment as a useful antiseptic when used in 
pure form to swab out open wounds that are infected. The use of the 
carbolized spray over wounds has been found to do more harm than 
good, and it ought never to be employed. 

As a disinfectant carbolic acid ranks among the poorest : 1 to 2 
per cent, solutions, however, kill most spores and germs. 

Untoward Effects. — Carbolic acid when applied as a dressing, even 
in as weak a strength as 3 per cent., to a finger or toe may cause gan- 
grene of the part severe enough to destroy it or to require amputation. 
Such strengths applied to the skin of the trunk rarely produce evil 
effects, probably because the circulation is not so completely cut off 
by the action of the drug on the blood-vessels. (See Plate I.) 

Administration. — Carbolic-acid ointment (TJnguentum Acidi Car- 
bolici, U. S. and B. P.) and the glycerite {Gclycerita Acidi Oarbolici, 
U. S.) are the only official preparations of carbolic acid in the 
U. S. P. In the B. P. the following preparations are official : Acidum 
Carbolicum Lic/uefactum, given in the dose of 1 to 2 minims (0.05- 
".10); (Jlycerinum Acidi Carbolici, Trocliiscus Acidi Carbolici, and 
Suppositorium Acidi Carbolici. 

CARBON (CHARCOAL). 

('(//•bo Ligni, U. S. and B. P., or Charcoal, is prepared by the 
exposure of soft wood to a red heat, air being prevented from coming 
in contact with the wood during the process. Charcoal when used 
for medicinal purposes should be a black, brittle, somewhat shiny, 
porous substance, devoid of taste and odor, and completely insoluble 
in water. 

Therapeutics. — Charcoal is used externally as an application to old 
sores or sloughs to act as a deodorant and antiseptic* These things 
it accomplishes by the absorption of -any liquids which may be present, 
thereby depriving germs of a nidus, and by its distinct oxidizing 
power. It may be applied in the form of a dry powder or in a poul- 
tice, which is, however, so uncleanly that other antiseptic dressings 
arc Letter. 

The poultice (Cataplasma Oarbonis), if used, should be made 



PLATE I. 




CARBOLIC GANGRENE. 

Appearance of a finger four weeks after the appli- 
cation for twenty-four hours of a dilute solution of 
carbolic acid. The finger was wrapped in cloths which 
were saturated with the carbolic solution not stronger 
than five per cent. Amputation necessary. Inflamma- 
tory process at the base of the finger shown by the 
reddened tissues. (Harrington's ease.) 



CARDAMOM. 145 

in the following manner : Take of powdered wood-charcoal 1 ounce 
(15.0), bread-crumbs 2 ounces (60.0), linseed meal 11 ounces (45.0), 
and add boiling water 10 fluidounces (300.0). Macerate the bread- 
crumbs and meal for ten minutes over a fire, and then stir in 
the charcoal to the extent of half the amount just named. Spread 
out the poultice and sprinkle the remaining half of the charcoal over 
its surface, and apply to the part affected while hot. 

Internally, charcoal is used in powder in many conditions, and 
acts very well indeed in cases of so-called " sour stomach" from 
which eructations of gas or sour liquids take place. 

The following prescription will also be found useful in the atonic 
or subacute gastric catarrh of persons who are careless in eating and 
who have much belching: 



R. — Oleoresin. capsici . 

Pancreatin. , . . 

Pulv. zingiberis . . 

Pulv. carbon, ligni 

Ft. in pil. No. xx. 

S. — One or two t. d. 



gtt. x vel xx (0.65-1.3). 

gr. xx (1.3). 

gr. xl (2.65). 

gr. xl (2.65).— M. 



As ordinary charcoal is not always obtainable, it may be substi- 
tuted by pieces of very thin toast burnt through and through till they 
resemble charcoal. If the attack is very severe and vomiting eventu- 
ally ensues, the ejecta will commonly be found to be odorless and not 
sour, and the stools will also be almost odorless, though black. In 
fermentative and acid diarrhoeas in adults this method of treatment 
is often of value, the prescription given above being a valuable means 
of cure. When charcoal is used in any condition associated with 
irritation of the mucous membranes of the gastro-intestinal tract, it 
should always be very finely pulverized, and if the stomach or bowels 
are inflamed the capsicum must be excluded from the prescription. 

As a filter for impure water, charcoal, in mass or in powder, is one 
of the most satisfactory substances we have. 



CARDAMOM. 

Cardamom (Cardamomum, U. S.) is the fruit of Elettaria lie- 
pens, and is a bitter tonic possessing some aromatic properties. It 
is useful in cases of atony of the stomach and small intestine, par- 
ticularly if combined with a mineral acid or some other bitter tonic, 
such as gentian. Cardamom is official in the B. P. as Cardamomi 
Semina. 

If the intestine is atonic and secretion is deficient, the following 
prescription will be found of value : 

R .—Acid, nitric, dil f^j (4.0). 

Tr. cardamomi comp q. s. ad f Jvj (180.0). 

S. — Dessertspoonful (8.0) after each meal. 1 

1 While the rule that an acid is incompatible with a tincture is not recognized in 
this mixture, the quantities of acid and alcohol are so disproportionate that ether in 
any amount is not developed. 
10 



146 DBUGS. 

Administration. — The official preparations of cardamoms are the 
tincture of cardamoms (Tinctura Cardamomi, TJ. $.), dose 1 to 3 
drachms (4.0-12.0) ; and the compound tincture (Tinctura Cardamomi 
Composita, TJ. S. and B. P.), which is to be given in the same dose 
as the tincture. This tincture also contains cochineal, cinnamon, 
caraway, and glycerin. Cardamom is also a constituent of the 
official aromatic powder (Pulvis Aromaticus, TJ. S.). 

CASCARA SAGRADA. 

Cascara Sagrada (B. P.) is the bark of the Bhamnus PursJiiana, 
TJ. a$'., a plant growing in California. It is sometimes called Cali- 
fornia buckthorn, to distinguish it from ordinary buckthorn or Bliam- 
nus Frangula, which it closely resembles in many ways, and which 
may be used as a substitute for cascara sagrada in some cases. 

Therapeutics. — Cascara sagrada ought never to be used as a purge, 
bur only as a laxative. It is by far the best remedy we have when 
employed simply to empty the bowel of faecal matter in cases of con- 
stipation, since it not only performs this function without intestinal 
disturbance, but simultaneously acts as a tonic to the intestine, and 
so prevents the constipation which usually follows the use of all other 
dru^s of its class. 

Cascara sagrada is most commonly employed in this country in the 
form of the fluid extract (JExtractum Bhamni Purshiance Fluidum, 
TJ. >S'., or Extractum Cascarce Sagradce Liquidum, B. P.), in the dose 
of from 10 to 20 minims (0.65-1.30) at night or morning and night. 
If 20 minims (1.3) fail to act, 30 minims (2.0) may be used; but if larger 
• loses are required, other drugs should be employed as adjuvants, as 
fluidrachm doses of the fluid extract of cascara may produce irritation 
of the bowel, and enteritis or intestinal catarrh. The objection to 
cascara sagrada is its bitter taste, which may be partially overcome by 
the additional use of the Syrupus Aurantii, in the proportion of 1 part 
of the cascara extract to 2 parts of the syrup of orange-peel. The 
B. P. has a preparation, Syrupus Cascarce Aromaticus, which is given 
in the dose of 1 to 4 drachms (4.0-15.0). 

Some of the preparations of this drug are now made in an almost 
tasteless form, such as " Cascara Cordial," an aromatic preparation 
useful for children who are constipated, or the non-bitter fluid ex- 
tract made by a prominent firm in this country and called " Cascara 
Evacuant," and used in the dose of 20 minims (1.3). The solid extract 
( Extractum ( uscarce Sagrada*) is official in the B. P., and is given in 
the dose of 2 to <s grains (0.1-0.5) in pill. 

CASSIA FISTULA. 

Cassia Vistula, TJ. &, is the fruit of Cassia Fistula, or Purging 
Cassia, as it is sometimes called, and occurs in long, dark -brown pods 
containing a dark pulp in each segment. This pulp is the useful part 
of the drug, and is official in the B. P. as Cassia* Pulpa. Cassia 
fistula OUghl never to be used alone, as it is too apt to cause pain 



CASTOR OIL. 147 

and griping, but it is officially present in the Confection of Senna 
(Confectio Sennas, U. S. and B. P.), and may be given in the dose of 
\ drachm to 1 drachm (2.0-4.0) as a laxative, or as much as \ ounce 
(15.0) may be used if a purgative eifect is desired. 



CASTOR OIL. 

Castor Oil {Oleum Ricini, TJ. S. and B. P.) is a fixed oil derived 
by expression from the beans of Ricinus Communis, a plant of the 
United States and elsewhere, but originally derived from India. It 
contains an acrid substance, ricinoleic acid. 

Physiological Action. — The manner in which castor oil purges is 
somewhat in doubt, but its activity probably depends upon the pres- 
ence of the acid just named and the fact that it is an oil. 

As is well known, oils — such as olive oil, for example — if given in 
considerable quantity, tend to move the bowels, and the ricinoleic acid, 
which is somewhat acrid, stimulates the small and large gut, and so 
develops peristaltic movement. According to some writers, this acid is 
not set free until the oil is attacked by the pancreatic juice. That this 
acid possesses purgative properties of itself seems proved by the fact 
that the oil will purge when it is rubbed in by the skin, and that nurs- 
ing mothers on taking the oil eliminate the acid in the milk to such an 
extent that the suckling is purged. According to the studies of 
Rutherford and Vignal, the oil has no effect over biliary secretion 
other than that violent purgation indirectly increases the flow, and 
the researches of Hess have shown that the oil acts more rapidly in 
the small than in the large gut, and only produces peristalsis by 
coming in contact with the mucous membrane. 

Therapeutics. — Castor oil is the blandest and most unirritating 
purge we have, with the exception of the sulphate of magnesium, 
which is depletant and much more rapid in its effects. While the Epsom 
salt will act in one half to one hour if the stomach is empty, castor 
oil will generally act in four hours, or perhaps five. 

Castor oil is used whenever irritant materials, such as bad food, 
putrid flesh, or decaying or green vegetables, have been eaten, even 
if the inflammation set up after them is very active. If hard bodies, 
such as broken cherry-stones, have been swallowed, castor oil is a far 
better purge than sulphate of magnesium, as it is more gentle and 
lubricates the gut, thereby preventing scraping and irritation. Where 
mucus has accumulated in the bowel in children, and must be gotten 
rid of before other treatment is resorted to, castor oil should be used. 
Previous to parturition it has been largely used to relieve the bowels 
of faecal matter, and is said by some practitioners to make the labor 
easier than if any other purge is used. This is doubtful. It is also 
employed in the constipation following acute diseases and in that 
occurring in infants and children. 

The disadvantages of castor oil lie in its taste, the fact that it is 
oily, that it tends to produce hemorrhoids if used constantly, and 
finally that its frequent use, or even a single dose, is generally fol- 



148 DRUGS. 

lowed by more obstinate constipation than existed before, so that the 
dose must be rapidly increased in size to be effective. This is one of 
the reasons why it is useful in irritative diarrhoeas, for having swept out 
the mucus and offending matter it checks the movements of the bowels 
afterward. The purgative effect of castor oil is very much increased 
if a little bicarbonate of sodium is given with it. 

Recent reports show that some cases of severe neuralgic headache 
may be cured by the use of small daily doses of castor oil. How it 
acts is not known, unless it unloads the bowels and so prevents 
toxaemia, which, in turn, has caused nervous irritation. 

Administration. — Castor oil is very much more agreeable to the 
taste if pure than if poorly prepared. It is also true that too great 
purification renders it less active. 

The methods directed for taking castor oil are as various as the 
tastes of individuals. Its odor may be covered by a drop or two of 
the oil of bitter almonds, but emulsions of the oil are not of any ser- 
vice, save to interfere with its efficiency. Some take the oil in the 
foam of beer or porter, others in syrup of sarsaparilla and soda- 
water, and still others in milk or cream. A good way to take it is 
to eat one or two strong so-called cream peppermint drops, or even 
the crystalline peppermint drops, swallow the oil from a spoon which 
is to be placed well back in the mouth, and immediately eat several 
other peppermints. This plan is improved by using the oil in milk 
or water, so that the liquid carries the oil down into the oesophagus 
without its touching the mucous membranes. It may also be taken 
in highly seasoned beef-tea. Ringer recommends the following: \ 
ounce (15.0) of oil, fresh syrup of acacia 3 drachms (12.0), and dis- 
tilled water 5 drachms (20.0), flavored with a little oil of lemon or 
peppermint. Wood advises that it be mixed with glycerin, equal 
parts, to which is added a drop or two of oil of gaultheria or oil of 
cinnamon. By far the best way of administering it is in soft capsules 
containing from \ to 1 drachm (1.0-4.0). Most persons can swallow 
as much as a teaspoonful in capsule, and several capsules containing 
this quantity, or a smaller amount, may be given at once to complete 
the necessary dose. The capsules should be dipped in water in order 
t<> render them slippery and so more easily swallowed. 

The dose of castor oil for an infant is 1 to 2 fluidrachms (4.0-8.0), 
and for an adult \ to 1 fluidounce (15.0-30.0). Often, however, small 
will act when it is desired to sweep out of the bowel foreign 
matter that is causing diarrhoea. 

Owing to the fact that the oil will very frequently produce griping, 
a frw drops of laudanum should be added to it, or tincture of bella- 
donna may he used. If these cannot be employed, a drop of the oil 
of cinnamon i- equally useful for this purpose. 

I mler the name of Mistura Oiei Eicinz the B. P. recognizes a 
mixture of castor oil made into an emulsion and given in the dose of 
1 to 2 fluidounces (30.0-60.0). 



CATECHU— CAUSTIC POTASH. 149 



CATECHU. 

Catechu ( U. S.) is derived as an extract from Acacia Catechu. 
The catechu of the U. S. P. is true catechu; that of the B. P. is in 
reality an extract of gambier, being derived from the leaves and shoots 
of Uncaria G-ambier. Catechu depends for its medicinal use upon the 
astringent properties which it possesses. Beyond this power it has 
no particular value. 

It is of a dark-red color, has a somewhat sweetish taste, and is 
insoluble, like most extracts, in water. 

Therapeutics. — Like all the vegetable astringents, catechu is used as 
a remedy for diarrhoea, particularly that of the serous type or that in 
which the stools are of too fluid a consistency. If large amounts of 
mucus in the passages show a catarrhal state of the bowel, the mucus 
should be displaced by a purge of castor oil or sulphate of magnesium 
before the astringent is used. 

Catechu may or may not be combined with opium in cases of diar- 
rhoea, but the following prescription will be found of service in many 
instances : 

For an adult : 

R. — Tinct. catechu composit fjfij (60.0). 

Tinct. opii camphoratse ffij (60.0). 

Misturae cretse fjij (60.0).— M. 

S. — Dessertspoonful (8.0) every four hours till relieved. To be shaken before using. 

In cases of sore throat where the secretion is excessive and the 
inflammation subacute catechu may be used as a gargle. 

In cases of spongy gums catechu is sometimes useful as a mouth- 
wash. If the powdered catechu is used internally, the dose is 20 to 
30 grains (0.1-2.0). The dose of the Compound Tincture of Catechu 
(Tinctura Catechu Composita, U. S.) is 1 to 2 fluidrachms (4.0-8.0). 
Its onlv constituent besides the catechu is cinnamon. The Troches 
of Catechu (Trochisci Catechu, U. S. and B. P.) are to be employed 
in sore throat, and are to be held in the mouth. They are not gen- 
erally used. 

The official preparations of the B.P., besides the ones given, are: 
the tincture (Tinctura Catechu), dose 1 to 2 fluidrachms (4.0-8.0); and 
a compound powder (Pubis Catechu Compositus), composed of catechu, 
kino, and rhatany, the dose of which is 20 to 40 grains (1.3-2.6). 

CAUSTIC POTASH. 

Caustic Potash (Potassa, U. S.; Potassa Caustica, B. P.) is a hard 
white solid, which readily deliquesces ; it possesses great caustic power, 
and is used in medicine for the purpose of burning away groivths or 
exuberant ulcers. In small cutaneous cancers it is applied to the spot 
for a minute or two after the protecting scab is removed. The parts 
are then poulticed for several days, when the slough comes away. A 
piece of the drug, if placed on the skin by means of a pair of forceps, 
will at once soften and burn the tissues until it can reach no firth er. 
The surrounding skin should be protected by wax, suet, or oils, and a 



150 DRUGS. 

piece of adhesive plaster with a hole for the growth should first be 
applied to prevent action on the surrounding healthy tissues. The 
hum produced by caustic potash is very painful, and cauterization 
through its influence should not be practised if it can be avoided. 
When the caustic has acted sufficiently, it is to be washed off with 
vinegar or other dilute acid to neutralize it. Vienna paste (Potassa 
cum Calce, U. S.) is used for the same purpose as is caustic potash. 

CAUSTIC SODA. 

Caustic Soda (Soda, U. S. ; Soda Caustica, B. P.) is milder than 
caustic potash, and its action is more readily controlled. It should 
be used in the same way and for the same purposes as is caustic pot- 
ash, and the surrounding skin ought to be protected by adhesive 
plaster and oil or ointment. 

The soda must be kept in well-stoppered bottles made of hard, 
strong glass. The only official preparation of caustic soda in the 
U. S. P. is Liquor Sodas, or solution of soda. 



CERIUM OXALATE. 

Cerium Oxalate (Cerii Oxalas, U. S. and B. P.) is a white granular 
powder, permanent when exposed to the air, odorless and tasteless, 
and insoluble in water and alcohol, but freely so in hydrochloric acid. 

Therapeutics. — It is often used instead of or combined with bismuth 
in the treatment of the vomiting of pregnane!/ or that due to uterine 
disorders and displacements, and in some cases of gastric acidity. The 
dose is from 2 to 5 grains (0.10-0.3), given in pill-form every four or 
five hours. 

CHENOPODIUM. 

Chenopodium ( U. S.) is the fruit of the Chenopodium ambrosioides, 
or American wormseed. The seeds contain a volatile oil and have a 
distinct and rather disagreeable aromatic odor. These seeds, rubbed 
up into a powder, form with a syrup an electuary which is a most 
efficient remedy against the ascaris lumbricoides, or round-worm, as it 
occurs in children. The dose of the powdered seeds is from 10 to 30 
grains (0.65-2.0). The better way of using chenopodium is in the 
form of the oil (Oleum Chenopodii, U. S.) in the dose of 10 minims 
(0.6) to a child of five years, either on sugar or in an emulsion made 
of gum acacia. If the patient is old enough, capsules may be used. 
The general dietetic measures adopted for the removal of worms should 
be insisted upon before the drug is given. (See article on Worms.) 



CHIMAPHILA. 



n in 



Chimaphila {U. >S'.), or Pipsissewa, is the leaves of Chimaphila 
bellata, an evergreen found in America, Europe, and Asia. 



CHIRETA— CHLORAL. 151 

Therapeutics. — Pipsissewa is a drug employed in atonic renal con- 
ditions, particularly of the functional type, as a stimulating diuretic, 
which will bring into activity the secreting structure of the kidney 
and the mucous membrane of the genito-urinary tract. It is also a 
tonic to the stomach. For this reason it is often placed in mixtures 
given to dropsical patients if debility and anorexia are present. In 
the treatment of ulcers of the skin due to struma it is said to be of 
service, and it probably has some slight alterative power. The drug 
may be used in the form of a decoction, which is not official, in the 
dose of 1 to 3 fluidounces (30.0-90.0), and as the fluid extract 
(Extr actum Chimaphilw Fluidum, U. S.) in the dose of ^ to 1 drachm 
(2.0-4.0). 

CHIRETA. 

Chireta (Chirata, U. S. and B. P.) is the plant Swertia Chirata, 
which is a native of India. It is a bitter tonic, possessing a very 
distinct influence over the liver, and, unlike many bitter tonics, is 
devoid of tannic acid. For this reason it may be used with prepara- 
tions of iron. Chireta may be given in cases of indigestion and loss 
of appetite, particularly where the liver is torpid or if any tendency 
to constipation is present, although it is not directly laxative. When 
given in powder the dose is 20 grains (1.3) ; the dose of the fluid 
extract (Extr actum Qhiratoe Fluidum, U. S.) is 30 minims to 1 
drachm (2.0-4.0), while that of the tincture (Tincture? Chiratce, U. S. 
and B. P.) is 1 to 4 drachms (4.0-16.0). The unofficial solid extract 
may be given in pill in the dose of 2 to 4 grains (0.1-0.2). The dose 
of the infusion (Infusum Chiratoz, B. P.) is a wineglassful (32. 0). Liquor 
Chiratce Concentratus, B. P., is given in the dose of 1 drachm (4.0). 



CHLORAL. 

Although the name Chloral is applied to the substance used in 
medicine, chloral itself is never so employed, hydrate of chloral 
(Chloral Hydras, B. P. ; Chloral, U. S.) being the real preparation. 
Chloral hydrate is a white, crystalline body, but is often sold in irreg- 
ular broken masses, which are generally impure. It should be kept 
in tight bottles in a cool, dark place. 

Physiological Action. — When chloral is applied to a mucous mem- 
brane it causes distinct reddening and burning pain, and finally acute 
inflammation. It is, therefore, a local irritant. Chloral acts in the 
body as chloral, and is not broken up into formic acid and chloro- 
form, as was taught at one time. 

Nervous System. — In medicinal and toxic dose chloral produces 
sleep by quieting the intellectual centres in the brain, at the same 
time depressing the motor tract of the spinal cord and the motor 
nerves. In medicinal amounts it does not decrease sensation, but in 
toxic doses it does. Very often hyperesthesia of the skin results from 
small doses. Reflex action is decreased by its sedative influence on the 
motor portions of the spinal cord. 



152 



DRUGS. 



Circulation. — A dose of 10 to 20 grains (0.65-1.20) in the healthy 
adult rarely causes any circulatory change, but larger amounts pro- 
duce a fall of arterial pressure and a slow, feeble, or sometimes a rapid- 
running pulse, due to a direct depression of the heart-muscle, for 
chloral in overdose is a cardiac paralyzant. 

After death from chloral the blood may be found dark and grumous- 
looking, with the corpuscles broken down, but these changes occur 
only after very large doses. 

Respiration. — In moderate amounts no respiratory effect is felt, 
but in toxic doses the breathing becomes slower and slower and more 



Fig. 18. 



Fig. 17 




Fig. 17.— A, Chloral causes sleep by 'quieting intellectual centres in brain. 

Fig. is.—//. Depresses motor centrifugal tracts of cord; C, depresses motor nerves; D, does not 

depress the muscles. 
Fro. 19. -/■:. Depresses heart-muscle. 

-/■', Depress-.- tli. respiratory centre. 

and more shallow, until it stops in death. When death is caused by 
chloral it is primarily due to respiratory failure, but there is an almost 
simultaneous arrest of the heart. 

Temperature. — Chloral tends to lower bodily heat, and in large 
produces a very marked fall of temperature, which does much 
toward causing death. Brunton has found that animals will survive 
very large doses of the drug if external heat is supplied to them. 
The fall of temperature is, at least in part, due to the failure of the 
circulation and to vascular dilatation. 



CHLORAL. 



153 



Kidneys, Tissue-waste, and Elimination. — Chloral is elimi- 
nated by the kidneys in the form of uro-chloralic acid and, if given 
in excess, as chloral. Poisonous doses irritate these organs, and may 
produce bloody urine, owing to the nephritis which is set up as the 
drug passes through the renal structures. After chloral is ingested 
tho urine of a patient will often react to Fehling's test for sugar. 

Poisoning. — When a poisonous dose of chloral is taken by man, 
the person soon falls asleep and then sinks into a deep coma. The res- 
pirations become at first slow and labored, then shallow and feeble. 
The pulse, at first perhaps a little slowed, soon becomes thready and 
shuttle-like, and is finally lost at the wrist. The face is white and livid, 
the forehead and the hands covered with a cold sweat, and the pupils, 
which are at first contracted, soon become widely dilated. Abso- 
lute muscular relaxation is present, and it is impossible to arouse the 
patient. 

Treatment of Poisoning. — The physician should apply external 
heat and use emetics in the early stages, or, if the case is seen too late 
for emetics to act because of systemic depression, he should use the 
stomach-pump. This latter means of removing the drug from the 
stomach is safer and more reliable, because the production of vomit- 
ing may result in efforts which will strain the heart. Strychnine 
should be given in full dose, 2V *° to °^ a g ra i n (0.003-0.006) to 
stimulate respiration, or atropine may be used for the same purpose. 
The heart is to be supported by 10-minim (0.65) doses of tincture of 
digitalis, given hypodermically every twenty minutes until some effect 

Fig. 21. 




Shows the effect of digitalis in raising blood-pressure and pulse-force in chloral poisoning (alter 
Schrniedeberg) : In I the pressure is very low because of the effect of a large dose of 
chloral ; the blood-pressure is 40; in II, after the injection of digitalis, it is 60; and in III 
it is 125, and the individual pulse beat is far stronger than before. 

is noted ; and, as the digitalis is rather slow in its action, it may be 
preceded by ether and ammonia or brandy or whiskey. The patient 



154 DRUGS. 

must not raise the head to vomit, and the head should be placed on a 
lower level than the heels to aid in maintaining the circulation of blood, 
in the vital centres at the base of the brain. 

In chronic poisoning by chloral or in cases in which the patient has 
come to use the drug as a habit the patient suffers from weakness, men- 
tal and physical, with sudden flushings due to vasomotor disorder, from 
palpitation of the heart, and finally from petechial eruptions, bed-sores, 
ulcerations, and sloughs. 

Therapeutics. — Chloral is the purest hypnotic that we have, and 
may therefore be used where simple nervous insomnia is present, but 
not when sleeplessness is due to pain. Under such circumstances it is 
to be employed in the combination of 10 grains (0.65) of chloral with 
£ of a grain (0.01) of morphine, as a much more powerful hypnotic 
effect is produced by the combined action of the two drugs than by 
the use of either one of them alone. 

The following prescription may be used : 

R.— Chloralis sjij vel iv (8.0-15.0). 

Morphinae sulphatis gr. ij (0.1). 

Syr. lactucarii (Aubergier) .... f*5ij (60.0). 

Aquae dest q. s. ad f Ifiij (90.0). — M. 

S. — Dessertspoonful (8.0), in water, at 10, and at 11 p. m. if necessary. 

In tetanus and strychnine-poisoning chloral is one of the best remedies 
we have, as it depresses the motor tract of the spinal cord. In such a case 
it should be given in 20-grain (1.3) doses combined with 60 grains (4.0) 
of bromide of potassium. If the convulsion prevents deglutition or is 
brought on by swallowing, these remedies should be used by the rectum 
dissolved in starch- w r ater ; and if the spasm expels them from the rectum, 
the patient should be chloroformed long enough to allow the injection to 
be given and absorbed. The same remedies in small doses are to be used 
in infantile convulsions and in infantile colic in the dose by the mouth 
of J grain to 1 grain (0.03-0.06) of chloral to 2 grains (0.1) of bromide 
of potassium or sodium in a teaspoonful of peppermint-water and syrup. 
In chorea, paralysis agitans, and delirium tremens chloral is of great 
service, but must be given cautiously in the last-named condition, for 
fear it may depress the heart, which is already diseased by alcoholic ex- 
cess. Cases are on record in which chloral has caused sudden death from 
cardiac failure in the persons of alcoholics with fatty heart — an accident 
the liability to which is increased by the fact that owing to the addiction 
of the patient to a narcotic drug it requires large doses to produce sleep. 
In uroBmic convulsions chloral has been highly extolled, but if any 
acute renal trouble is present, it must not be used, lest it irritate the 
kidneys. In puerperal convulsions not dependent upon nephritis 20 
to 30 grains (1.3-2.0) of the drug may be given, and repeated in one 
or two hours. 

Hiccoughs, nocturnal epilepsy, and whooping cough are all indi- 
cations for its use, but in asthma it rarely does good, and if pushed 
is dangerous to the heart. 

Untoward Effects. — Chloral sometimes causes nausea, purging, and 
vomiting by reason of its irritant action. Tn susceptible persons doses 
of L0 to \~> grains have produced marked redness of the eyes with 
swelling of the conjunctiva. Sometimes the last-named symptoms are 



CHLORALAMIDE. 155 

only produced when an alcoholic beverage is taken simultaneously. 
In still other cases an erythematous, papular, urticarial, vesicular, or 
petechial eruption may ensue, the latter forms being seen as a rule in 
cases of chronic chloralism. 

Administration. — Chloral is best given in syrup of acacia, simple 
syrup, or water. It should be always well diluted. The syrup of 
chloral (Syrupus Chloral, B. P.) is given in the dose of 1 fluidrachm 
(4.0). The following prescription is useful in insomnia : 

R.— Chloralis £jvel ^ij (4.0-8.0). 

Potassii bromidi .^ij (8.0). 

Syr. pruni virginianae f|j (30.0). 

Aquas q. s. ad f §iij (90.0).— M. 

S. — Dessertspoonful (8.0) at night. 

Sometimes chloral can be well given in junket by adding it to a 
liquid rennet, and then adding the rennet to the milk. (See Junket, 
Part III.) 

The question as to the safe dose of chloral is one largely governed 
by the susceptibility of the patient, but alarming symptoms have fol- 
lowed a dose of 30 grains, and death after from 30 to 45 grains. 
Thirty grains in twenty-four hours is certainly ample in most cases. 

CHLORAL AMIDE. 

Chloralamide is a compound very recently introduced into medi- 
cine, formed by the addition of formamide to anhydrate of chloral, 
and is a colorless crystalline substance, soluble in 9 parts of water 
and 1J parts of alcohol. Its taste is slightly bitter, but not biting, 
and it keeps well in watery solution without decomposition. Its 
physiological action is closely allied to that of chloral, except that it 
is not quite so depressing to the circulation. Upon the nervous sys- 
tem it acts chiefly upon the brain and spinal cord, and produces sleep 
— a result to be expected, since both chloral and formamide are hyp- 
notics. It is said not to irritate the stomach and kidneys, but it 
probably is only less irritant than chloral. 

Therapeutics. — Chloralamide may be employed in medicine when- 
ever chloral may be used. It is decidedly a nervous sedative, and in 
the wakefulness of nervous insomnia is very useful. Sleep generally 
ensues about thirty to forty -five minutes after it is taken. According 
to most of the reports published so far, the drug relieves pain as well 
as produces sleep, and is therefore distinct in its actions from chloral. 
In neuralgia it is very useful, and it has been found of value in the 
pains of tabes dorsalis. The dose is 10 to 30 grains (0.65-2.0), which 
may be repeated in three or four hours, although the sleep generally 
lasts five to eight hours. The following formula may be used for its 
administration : 

R. — Chloralamide gr. xl (2.6). 

Acid, hydrochlorici dil rr^ v (0.3). 

Syrupi f#j (8.0). 

Aqu^dest. . . ._ fjij (60.0).— M. 

S. — Take in two doses in a little water. 



156 DRUGS. 

The late Professor Charteris claimed very extraordinary results 
in the treatment of sea-sickness by the use of equal parts of chloral- 
amide and bromide of potassium. He gave it in the dose of 30 grains 
(2.0) with an equal amount of the bromide. It is necessary for the 
patient to take a cholagogue for two days before starting on his voyage, 
and as soon as he gets on board the ship to take the dose named on an 
empty stomach, and at once to go to bed and to sleep. If this is done, 
Charteris claimed that the patient will awake feeling bright and well, 
and remain so for the rest of the voyage. This combination under the 
name of " chlorobrom" has been also largely used as a hypnotic in the 
treatment of the insomnia due to melancholia and acute mania. 



CHLORALOSB. 

Chloralose is a compound made from anhydrous chloral and glu- 
cose, is soluble in hot water and alcohol, and was introduced into 
medicine as a safe hypnotic and substitute for chloral. Unfortu- 
nately its taste is acrid, and to some persons nauseous, particularly 
if taken in water. 

Physiological Action. —The physiological action is practically iden- 
tical with that of chloral, but much more mild if the researches of 
Mosso are correct. Its dominant effect is on the brain, and full doses 
depress the spinal cord and heart. Poisonous doses may produce 
hemoglobinuria. 

Therapeutics. — The indications for the drug are functional insom- 
nia, and the beginning dose is 2 to 7 grains (0.1-0.5), but the smaller 
dose should always be tried first, particularly in women. Sleep fol- 
lows its ingestion in about half an hour. 

The best way to administer the drug is to give it in capsules or 
cachets, and to follow it with a glass of water or milk. 

Untoward Effects. — Sometimes chloralose produces diplopia, muscu- 
lar tremors, or constant passing of the hands over the head and face. 
If a habit is induced by its constant use, it is a noteworthy fact that 
its power to produce sleep is decreased, while the untoward effects are 
more likely to be marked. In nervous and tuberculous patients it 
sometimes causes tetanic or cataleptic symptoms with disturbed intel- 
lection. 



CHLORATE OF POTASSIUM. 

Chlorate of Potassium {Potassii CJrforas, U. S. and B. P.) is a 
salt of potassium differing entirely in its physiological action from all 
the other potassium salts, and, with the exception of the cyanide of 
potassium, is certainly the most poisonous. Not only is it, when 
locally applied, an irritant to mucous membranes, but when it is 
absorbed into the blood it causes changes of a serious character in 
this fluid, and produces acute nephritis if given in overdose. 

In dry form chlorate of potassium ought never to be rubbed with 
organic Bubstances in a mortar, as an explosion may occur. 

Physiological Action. — It has been thought by some that chlorate 



CHLORATE OF POTASSIUM. 157 

of potassium gives up a large amount of oxygen to the body, and that 
for this reason it would be of value in cases of slow asphyxia, such 
as result from pneumonia or phthisis. It has even been recommended 
to persons crossing high mountains where the rarity of the air pro- 
duced disagreeable effects; but nothing is more absurd than the 
belief that it gives up oxygen to the body. Chlorate of potassium 
does give off oxygen when treated with very high heat, but not at 
the temperature of the body. Nearly all of it escapes from the body 
unchanged. 

When overdoses of the chlorate are taken, it produces sickness of 
the stomach, headache, pain in the loins and belly, dyspnoea, cyano- 
sis, heart-failure, and great weakness. Poisonous doses cause the 
blood to be of a chocolate color, this change being due to the produc- 
tion of methoemoglobin. The blood-corpuscles are crenated and broken 
down, and after death the liver, kidneys, and spleen are found soft- 
ened and filled with broken-down and disorganized blood. 

Therapeutics. — Chlorate of potassium is useful in stomatitis and in 
mercurial sore mouth as a mouth-wash, or, given internally, in the 
following mixture: 

B . — Potassii chlorat gr. xlviij (3.0). 

Tr. myrrh f ^ss (2.0). 

Elixir calisayse q. s. ad f ^iij (96.0). — M. 

S. — Teaspoonful (4.0) every five hours, or use as a mouth-wash. 

Owing to the fact that the drug is eliminated by the saliva to a 
great extent, the mucous membranes affected by stomatitis are con- 
stantly bathed by a solution of the chlorate when it is taken by the 
stomach. If any irritation of the stomach or kidneys exist the medi- 
cament must be used on a swab and none of it swallowed. 

In diphtheria chlorate of potassium is very commonly employed, 
but its use is exceedingly dangerous. Death in many cases of diph- 
theria is due to the renal irritation present, or, in other words, to an 
acute nephritis, and this drug simply increases the inflammatory pro- 
cess. If the chlorate of potassium is employed in diphtheria it 
should be used in solution and applied by means of a swab. (See 
Diphtheria.) 

In acute follicular pharyngitis chlorate of potassium is a useful 
gargle, and Wood recommends the use of a solution made by adding 
1 ounce (30.0) of sumach-berries, J ounce (15.0) of chlorate of potas- 
sium, and 1 pint (500 cc.) of boiling water to each other, and allowing 
them to simmer for a few hours, when the mixture should be strained, 
cooled, and used as a gargle. 

The following is equally serviceable : 

R .—Potassii chlorat 3j (4.0). 

Ext. rhois glabrae fl t\? ss (15-0). 

Aquas dest q. s. ad fjiij (90.0). — M. 

S. — To be added to an equal quantity of water in a glass and used as a gargle every 
two hours, after stirring. 

This prescription makes an abominable-looking pharmaceutical 
preparation, but an exceedingly useful one. 



158 DRUGS. 

In acute rectal catarrh with mucous diarrhoea and tenesmus a 
solution of chlorate of potassium in water, 20 grains (1.3) to the 
ounce, injected into the bowel, will often produce a cure after one or 
two injections. Not more than 4 ounces (128.0) should be used, and 
it ought to be retained for twenty minutes. Often it will be well to 
add the saturated watery solution of the chlorate to an equal quantity 
of starch-water, as the latter aids in allaying the local irritation. 
This same method can be used in the treatment of hemorrhoids, and a 
few drops of laudanum, if added to this solution, will be found of great 
service. The troches (Trochisci Potassii Qhloratis, U. S. and B. P.) 
are given in the dose of 1 to 6, each lozenge containing 5 grains (0.3). 
They are intended to be dissolved in the mouth to affect the oral 
mucous membrane, but if many are used they are apt to disorder the 
stomach by reason of the drug being swallowed in the saliva. 

CHLORETONE. 

Under the name chloretone a substance, which is trichlor-tertiary- 
butyl-alcohol, has recently been introduced as a hypnotic and nervous 
sedative closely allied in its uses to chloral, yet differing in the impor- 
tant particulars that it does not depress the heart or respiration unless 
given in excessive quantities, and does not irritate the stomach > but 
acts as a sedative to this organ. For this reason it can be used with 
advantage in vomiting due to irritation and in gastric carcinoma to 
relieve pain. Given in the dose of 10 to 15 grains (0.65.-1.0) before 
etherization, it will often prevent after-vomiting, and if vomiting has 
already begun is a valuable agent for its relief. When used to pre- 
vent ether vomiting, it should be given in powder one hour before the 
ether is used. 

The author has also found it of value in relieving the pain of 
gastric ulcer and of gastredgia. As it is both anaesthetic and anti- 
septic, it can be employed as an application to burns, scalds, and 
lacerations in 10 per cent, ointment, and local anaesthesia may be pro- 
duced by the subcutaneous injection of it in a 1 per cent, solution of 
alcohol 15 per cent, and water 85 per cent. It may be dissolved in 
oil of cloves and applied on a cotton pledget with advantage in cases 
of toothache. It may be used to benumb a painful dental nerve by 
mixing equal parts of ether and chloretone and applying this in the 
cavity. Powdered chloretone mixed with equal parts of powdered boric 
acid and dusted over painful ulcer*, burns, and lacerations or wounds 
acts as an efficient antiseptic and pain-reliever. Chloretone and anti- 
pyrine may be placed in a capsule in the dose of 3 to 6 grains each 
and used in restlessness and neuralgia pain. The mixture of these 
substances results in liquefaction, but this does not interfere with 
their therapeutic efficacy. 

Chloretone is efficient in doses of from 10 to 20 grains (0.65-1.3), 
and is best given in sugar-coated tablets of about 3 grains (0.15) 
each. 



CHLORINATED LIME. 159 



CHLORINATED LIMB. 

Chlorinated Lime {Calx Chlorata, U. S. ; Calx Chlorinata, B. P.) 
is the hydrate of lime, containing 35 per cent, of chlorine, provided 
it is of official strength. It is an exceedingly irritant substance 
because of the chlorine which it contains, and is never used inter- 
nally. 

Much of the chlorinated lime sold is useless, containing too little 
or no free chlorine. Good chlorinated lime should be so laden with 
the gas that the face cannot be held near it without the eyes being 
severely irritated. Unless the chlorine is present, the lime is of no 
value, for the employment of chlorinated lime as a disinfectant depends 
upon the action of this gas, the lime being used merely as a vehicle and 
oxidizer, the gas by itself being difficult of application. 

Uses. — As a disinfectant for privies, drains, and sinks chlorinated 
lime is one of the best, if not the best, we possess. A few pounds 
of it may be added every week to the contents of a privy vault with 
great advantage, and a solution of it may be used in all bed-pans and 
urinals. When the passages of a patient having typhoid fever are to 
be received in a bed-pan, a chlorinated-lime solution should be placed 
in the receptacle beforehand, so that the faecal matter or urine will 
fall at once into a disinfecting fluid. The solution should be of the 
strength of 1 pound to 2 gallons. As it is one of the most powerful 
deodorizers, chlorinated lime should be placed liberally over and about 
decaying animals, and in exhuming corpses sheets wrung out in a solu- 
tion made as directed above will, if wrapped about the body, be found 
of service to destroy the stench. 

Water which has become foetid by stagnation may be rendered 
drinkable by adding 1 to 2 ounces of the chlorinated lime to every 
65 gallons, and standing the solution aside for some hours until pre- 
cipitation and exposure to the air have gone on for some time. 

It should be remembered that chlorine fumes will bleach many dyed 
goods, and therefore they cannot be used on colored fabrics. 

Chlorine gas, in a diluted form, has been used for the treatment of 
aphonia due to cold in cases where the aphonia persists for some 
months. It can be obtained by allowing a few drops of hydrochloric 
acid to fall upon chloride of lime or chloride of sodium. 

The placing of chlorinated lime in saucers about sinks and closets 
is useless, as the amount of chlorine liberated is very slight as com- 
pared to the volume of air in the room. Where the chlorine is pres- 
ent in a sufficiently concentrated form to kill germs, it will also kill 
the occupant of the chamber. A deodorant effect may be obtained, 
but a bad smell, if it exists, even when overcome by a greater one, 
is not really gotten rid of. The official preparations of the B. P. are 
Liquor Calais Chlorinates and Vapor Chlori. 

CHLORODYNE. 

Chlorodyne is a preparation used to a very large extent for the 
treatment of serous diarrhoeas or cramps in the abdomen. Its consti- 



160 DRUGS. 

tution varies considerably, but the formula most commonly used is as 
follows : 

R. — Morphinae kydrochlor. gr. viij (0.5). 

Aquje dest f^ss (2.0). 

Heat together, and as soon as the morphine is dissolved and the liquid cooled, add 

Acid, hvdrochlor. dil f ^ss (2.0). 

Chloroformi f £iss (6.0). 

Tr. cannab. indicse f^j (4.0). 

Acid, hvdrocvanic. dil f^xij (1.0). 

Alcoholis . f 5ss (16.0). 

01. menth. piperit f^xij ( 1.0;. 

Oleoresinse capsici H\j (0.05). — M. 

S. — 5 to 15 minims (0.35-1.0) for an adult, in water, every two hours for three 
doses. More than this quantity is dangerous. 

A formula closely allied to this is used in tablet form in repeated 
doses. 



CHLOROFORM. 

Chloroform (Chloroformum, U. S. and B. P.) was originally dis- 
covered by Guthrie (1831), of Sackett's Harbor, New York, but first 
brought into medicinal use (1847) by Simpson, of Edinburgh. It is a 
clear liquid wiih an exceedingly hot, burning, sweetish taste, of a rather 
agreeable odor, and is very volatile in the presence of ordinary air. Its 
chemical name is trichlormethane. 

There are two kinds of chloroform — the purified (Cliloroformum 
Purificatum, U. S.) and the commercial chloroform {Cliloroformum 
Vet/ale). Chloroform should be kept in a dark, cool place. 

If exposed to the light for any length of time, chloroform develops 
carbonyl chloride, hydrochloric acid, and chlorine, which render it unfit 
for use. If the acid is present it will turn blue litmus red, and if 
chlorine is present it will form a white precipitate with nitrate of silver. 
Such decomposed chloroform may be rectified by shaking the chloro- 
form with slaked lime and filtering till the irritating products are gotten 
lid of. If impure because of improper methods of manufacture, an 
oily odor will be left on the hand after evaporation takes place. We 
find, therefore, that chloroform fit for use should be absolutely trans- 
parent and colorless, neutral to test-paper, non-irritating when inhaled, 
and should evaporate entirely, leaving no residue or smell on a watch- 
glass. It should have a specific gravity of from 1.491 to 1.525, should 
form no precipitate with AgNG 3 , should not become brown when heated 
with caustic potash, and only very faintly brown, if at all, when shaken 
with concentrated H 2 S0 4 . The method of manufacture of Pictet, by 
which the chloroform is purified by crystallization, probably gives us 
the purest article In America, the chloroform made by Squibb, ot 
Brooklyn, i< almost universally employed. 

Chloroform vapor in the presence of gas-flame undergoes certain 
changes which result in the development of noxious and irritating 
fumes, consisting principally of hydrochloric acid and chlorine, which 
produce laryngeal and bronchial Irritation. 

Physiological Action. — Locally applied to the skin, chloroform may 



CHLOROFORM. 161 

produce some tingling and burning, even if evaporation be not inter- 
fered with. If it be confined under a watch-glass on the skin, it will 
cause a blister and act as a counter-irritant. 

When inhaled, chloroform produces a sensation of warmth in the 
mouth and throat, a feeling of relaxation, and finally unconsciousness. 
The respirations are at first full and deep, but soon become more 
rapid and shallow. The pulse may be somewhat stronger and fuller 
for a short interval, probably because of mental excitement, but soon 
fails in strength and becomes more rapid. The irritation produced in 
the air-passages by its inhalation is very slight, and no primary arrest 
of respiration ensues, as is generally seen after ether is first given. 
The pupils are at first slightly dilated, but are contracted during anaes- 
thesia. If the pupils dilate during the use of chloroform after the 
contraction just named, danger is imminent and death may suddenly 
occur. In some persons the first effects of chloroform are violent 
struggles, and there is danger in trying to overcome these struggles 
by pushing the drug very rapidly. This struggling is particularly 
apt to be met with in athletes and drunkards. Total muscular relaxa- 
tion should never be produced by the drug. 

Nervous System. — Chloroform first affects the brain, then the 
sensory part of the spinal cord, then the motor tract of the cord, then 
the sensory paths of the medulla oblongata, and finally the motor por- 
tion of the medulla, thereby producing death from failure of the vaso- 
motor centre and of the respiratory centre, unless, as rarely occurs, the 
heart has already succumbed to the drug. On the sensory and motor 
nerves, when locally applied, it acts as an irritant and anaesthetic. 
Upon these nerve-trunks, when taken by inhalation, it has little or no 
effect. 

Circulation and Respiration. — The effects of chloroform upon 
these vital functions have been for many years a subject of hot dispute 
between various surgeons and pharmacologists. On the one hand is 
the school originally led by Syme, of Edinburgh, which has asserted 
that death or danger from chloroform lay in failure of the respiration, 
and that this was the function to be watched while chloroform w T as 
being used; on the other hand, the so-called London school asserted 
that death arises from cardiac failure and that the pulse is the thing to 
be watched during the use of chloroform. The number of clinical and 
laboratory researches which have been carried out to determine which 
of these opinions is correct has been very great, both in England and 
in America, but it has only been within the last twenty years that 
the most competent studies have been undertaken, of which the best 
known is the series made through the munificence of His High- 
ness the Nizam of Hyderabad in India, and known as the " Reports of 
the Hyderabad Chloroform Commissions Nos. 1 and 2." The conclu- 
sions of the first commission having been criticised adversely because it 
asserted that the cause of death w r as respiratory failure, a second com- 
mission was formed, and, under a grant of $5000 from the Nizam, Sir 
Thomas Brunton of London was sent out to direct the second investi- 
gation. Although a teacher of the theory that death from chloroform 
is due to cardiac failure, this gentleman returned to England converted 
ll 



162 



DRUGS. 



to the idea that the cause of most of the fatal accidents under this drug 
is respiratory failure, and the conclusions of Commission No. 2 were 
once more criticised by numerous clinicians and pharmacologists in 

About this time H. C. "Wood and the author 



England and America. 



Fig. 22. 




Fig. 23. 




Fig. 24. 



B 





-E 



Fig. 22.— A, Chloroform depresses the vasomotor centre; />'. chloroform dilates the heart and 
"oroform depress* 



depresses it ; C, ehl 
Fig. 28.— A, Chloroform produce 



the respiratory centre 



ia by depressing the perceptive centres in the brain, 
and Later depresses the B, intellectual centres, and Anally depresses the C. motor centre. 



Fio. 24.— D, Depresses the sensory paths in the spinal cord 
in the cord. 



E, finally depresses motor tracts 



published a paper in which they expressed their belief in the powerful 
depressing effects produced by chloroform upon the heart; and Mac- 
Williams of Glasgow proved by experiment that chloroform without 
doubt causes cardiac dilatation and enfeeblement. Shortly after this 



CHLOROFORM. 



163 



the author of this book was asked by the government of His High- 
ness the Nizam, through Colonel Edward Lawrie, the Residency Sur- 
geon, to carry out a series of studies l designed if possible to reconcile 
the contradictory results reached by the Hyderabad Commissions and 
other investigators, and simultaneously Gaskell and Shore in Cam- 
bridge University, England, were asked to do likewise. The result 
has been to confirm in every way the results of all previous studies in 
one respect — namely, that the primary action of chloroform on the vital 
functions of circulation and respiration is greatly to depress the vaso- 
motor system, thereby causing an extraordinary fall of blood-pressure. 
Gaskell and Shore, to be sure, assert that anaesthesia can be produced by 
chloroform without causing this fall, but the author has never been able 
to do so (Fig. 17). They also believe that the fall is chiefly a result of car- 
diac failure. With this view the author dissents, because their experi- 
ments upon which these assertions are based were too complex to give 
practical results ; and second, because his own studies and those of others 
show the vasomotor system to be depressed. There is of course some 
cardiac enfeeblement and dilatation, which adds to the fall of pressure. 



Fig. 25. 




'WvVWVAaA/V/vv 



" i m i i i i i i i 1 1 i i i i i i ' i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i l i 1 1 i i i i i i [ i i i i i n i i i i 




Tracing showing the pulse and blood-pressure depressed by chloroform. Note the fall of 
blood-pressure which begins in the upper tracing and becomes marked in the second trac- 
ing. Also notice the weak pulse shown in the third tracing, illustrating the final depress- 
ant effect of the drug on the heart. The respiration ceased at X, but the heart continued 
to beat. The blood-pressure failed first, then the pulse, then the respiration, and last of 
all the heart stopped. (Reduced from natural size.) 



As with other discussions in medicine, the truth of the question as 
to whether chloroform causes death by respiratory failure or cardiac fail- 
ure lies, as it were, halfway between the two antagonistic forces ; and, 
further than this, the somewhat startling statement may be made that 
it is not directly due, in the majority of cases, to either of these causes. 
On the contrary, the cause of death from chloroform is usually vaso- 
motor depression, whereby the arterioles allow the blood to pass too 
1 See Therapeutic Gazette, October, 1893. 



164 DRUGS. 

freely into the great blood-vessel areas which are found in the capillaries 
and veins, and as a result the man is suddenly bled into his own vessels 
as effectually as if into a bowl. When it is remembered that the capil- 
lary network of the body will, with the relaxed veins, hold many times 
the normal quantity of blood, and when it is remembered that we can 
inject salt solutions into the vessels to the extent of several times the 
normal quantity of blood without raising the blood-pressure, it at once 
becomes evident that the complete vascular relaxation caused by chloro- 
form results in failure of all the vital functions, not because the drug 
has paralyzed the heart or respiratory centre, but because these parts 
are deprived of blood by its stagnation in the widely dilated capillaries 
and abdominal veins. Recent studies by Leonard Hill on The Physi- 
ology and Pathology of the Cerebral Circulation show that this is 
the case, for he asserts that when the blood is no longer flowing 
to the respiratory centres the heart is still beating, because its coro- 
nary arteries, being lower down, are more easily supplied by the small 
blood-stream received by the heart from the veins. These studies are 
proved by the experiments of myself and my assistant, Dr. Thornton, 1 
by every tracing of the Hyderabad Commissions, and all other tracings 
we have ever seen. We may conclude, therefore, that while chloroform 
without doubt acts as' a powerful depressant poison to the respiratory 
centre and the heart in the same manner as it paralyzes all living pro- 
toplasm when applied in excess, that when properly given by inhalation 
it produces a death equivalent to that resulting from hemorrhage, which 
is a failure of the respiration not so much from a direct depression of the 
respiratory centre as from its starvation of blood ; and while the tend- 
ency of the drug is to depress and dilate the heart, just as it dilates 
the vessels of which the heart is merely a highly specialized part, the 
failure in the pulse rests upon vasomotor palsy, the patient becoming 
pulseless because the heart has not any blood to pump. 

Let us see what evidence supports this view : First, we have the lab- 
oratory tracings of many independent investigators extending over many 
years and made in all parts of the world, all of which show a fall of 
blood-pressure. Among these may be named Bowditch and Minot of 
Boston, Coats, H. C. Wood, Gaskell and Shore, the Hyderabad Chlo- 
roform Commissions, the studies of Wood and myself in 1889 and 1890, 
and of myself and Thornton in 1892 and 1893. They are confirmed 
by Hill, who has seen the abdominal vessels engorged with blood under 
chloroform, the medulla almost bloodless, and the heart still pumping 
though respiration had ceased. They are confirmed by my own experi- 
ments, in which I proved that even after the respiration had stopped 
and the carotid was empty, and the dog apparently dead, he could be 
resuscitated by visceral compression and artificial respiration, and by 
inversion, whereby the blood left the dilated abdominal veins for the 
hearl and brain. Again, if a needle was inserted through the chest- 
wall, the heart was found to be beating, for the needle moved to and 
fro; and finally if the chest was opened the heart could still be found 
beating feebly — dilated, it is true, but beating. 

So much for the laboratory evidence. What have we in clinical evi- 

1 Therapeutic (l<t:,<ttr, October, 1893. 



CHLOROFORM. 165 

dence ? Equally positive proofs of vasomotor palsy, and none of death 
being purely cardiac or respiratory. For years Chisholni of Baltimore 
and later Howard Kelly and a large number of others have used inver- 
sion with compression of the floating ribs in artificial respiration, which 
has forced the blood into the chest and saved life again and again. For 
years the literature of medicine has teemed with reports of death from 
chloroform while the patient was sitting up or half recumbent, because, 
the blood-paths being dilated, this posture favored anaemia of the vital 
centres. Again, it has been proved that the best vasomotor stimu- 
lant — belladonna or atropine — given before the chloroform is used 
increases the safety of the patient, and that compression of the limbs 
by bandages does likewise. Finally, Hill has shown that abdominal 
compression also aids resuscitation by sending the blood to the heart. 
On the contrary, saline transfusion, which would seem to be indicated, 
is useless, because the dilated blood-paths will receive all the saline 
for a long time before they will overflow toward the heart, for as 
fast as the fluid flows in they dilate. 

The author therefore thinks that while chloroform in its general 
depressing power depresses all vital functions, it is the question of 
blood-pressure which is most important in the healthy individual, 
although the heart may fail if it be damaged by disease before the 
drug is used. Therefore in the use of chloroform we should always 
keep the head low, precede the use of chloroform by atropine hypo- 
dermically, bandage the limbs if the case is feeble or already blood- 
less, and if necessary place compresses on the belly and apply them 
deeply by pressure if failure of the circulation is developed. 

The primary action of the chloroform is to depress the blood-press- 
ure chiefly by its vasomotor effect, secondly by its cardiac effect, and 
finally, while the drug does exercise a depressant effect on the respi- 
ratory centre, the failure of this centre is chiefly due to anaemia. As, 
however, an intact respiratory centre means regular breathing, we 
watch this function to determine the dose of chloroform actually 
inhaled, and because any variation in this function, as shown in 
irregular breathing, means that the chloroform is disordering arterial 
tension. Death from chloroform in a healthy organism, then, is 
usually a vasomotor death, for an intact arterial system is as impor- 
tant to vital function as an intact cardiac apparatus. 

Blood. — Upon the blood in the body chloroform has little or no 
effect when it is inhaled. Shaken with chloroform in a bowl the blood 
becomes scarlet in hue. 

Temperature. — Chloroform when taken by inhalation distinctly 

lowers the bodily temperature, probably by aiding in the dissipation 

of heat and by its action on the nervous mechanism of heat-production. 

Elimination takes place by the lungs and by the kidneys, and 

goes on very rapidly, owing to the great volatility of the drug. 

If large amounts are eliminated by the kidneys, these organs are 
apt to become irritated and inflamed. 

Antiseptic Power. — Chloroform, when it is added to organic fluids, 
prevents all changes which depend upon the growth of micro-organ- 
isms. 



166 DRUGS. 

Therapeutics. — The first and most important use of chloroform is 
as an anaesthetic, and at this point we come to a question which has 
been for many years a matter of contention between different sections 
of the medical profession — namely, as to whether its use is dangerous. 
In the Southern and Western parts of the United States chloroform is 
nearly always used, but in the Eastern and Northern portions it is 
rarely employed. Southerners certainly seem to take chloroform 
better than Northerners or those living on the Atlantic coast. It. is 
impossible to go into a general discussion of this question here ; suffice it 
to state that even the most enthusiastic supporters of the use of chloro- 
form confess that it is a more dangerous drug than ether if carelessly 
used, and, while the advantages of chloroform are many, this one great 
disadvantage overshadows them all. 1 The advantages are — its more 
agreeable odor and the fact that it does not irritate the air-passages, 
owing to the small amount necessary to cause anaesthesia ; the fact 
that its use is less apt to be followed by nausea and vomiting ; the 
rapidity of its action ; and the small bulk which has to be carried by 
the surgeon. Its disadvantage is — the possibility of its killing the 
patient. 

We come, then, to the all-important questions : 

1. Is chloroform a safe anaesthetic ? 

2. Are we to watch the pulse or respiration during the use of the 
drug, and what are the signs in the respiratory function indicative of 
danger to the patient ? 

3. What is the true cause of death from chloroform ? 

4. Is death from chloroform possible when it is properly admin- 
istered? 

5. Under what circumstances is the surgeon to use chloroform in 
preference to the less dangerous anaesthetic, ether ? 

6. What is the best way of administering chloroform ? 

To the first question the answer is, Yes for the majority of cases, 
provided it is given by one who is skilled in its use, and not only 
knows how to give it, but how to detect signs of danger. It is not so 
safe as ether at any time, other things being equal, and never safe in 
the hands of a tyro. 

To the second question the answer is, Watch the respiration, 
because as soon as enough chloroform is used to endanger the circula- 
tion the respiration will show some signs of abnormality, either in 
depth, shallowness, or irregularity. In other words, the very effect 
of the drug may be to cause such deep and rapid respirations that an 
excessive quantity of the drug is taken into the lungs and continues 
to be absorbed even after the inhaler is withdrawn. 

As there is always a fall of blood-pressure under chloroform, it is 
difficult to feel the radial or temporal pulse, and the respiratory cen- 
tre recognizes the degree of arterial depression which its sister vaso- 
motor centre has permitted by finding that its blood-supply is insuf- 
ficient. As respiration fails first, it should be watched first. It is only 

1 The mortality based upon many tens of thousands of cases in which chloroform 
has been u>c(\ is about 1 in 2039 (<iurlt); or according to the combined statistics of 
Julliard and Ormsby, in (>7<J,7G7 administrations there were 214 deaths — 1 in 3162. 



CHLOROFORM. 167 

by watching the respiration that we can tell how much chloroform the 
patient is getting. We do not watch this function for danger alone, 
but to tell us of the dose. 

Every one is agreed that the patient taking chloroform should 
have plenty of fresh air, and in India, to all intents and purposes, 
patients are operated on in the open air, at least as compared to the 
closed rooms necessary in America and Europe. This free supply of 
air is important, whether we believe death to be imminent from cardiac 
or respiratory failure ; but this supply of air matters little to the patient 
if he does not breathe freely, nor does the amount of chloroform amount 
to aught if it is not drawn into the chest. The dose of chloroform is 
not the amount on the inhaler, but the amount taken into the chest, 
and, finally, the amount absorbed by the blood-vessels. The rapidity 
and depth of respiratory movements is, therefore, as Lawrie asserts, the 
entire key to the situation. We withdraw chloroform, as Lawrie says, 
whenever respiration becomes disturbed in rhythm or when struggling 
disturbs] it, because it is the first indication that the drug's action is 
uncertain, and because there is no telling the dose which is absorbed. 
While watching the respiration will not warn us of a sudden cardiac 
arrest in fatty heart plus chloroform depression, neither will the pulse 
give us such warning ; and we are confident that the statement of the 
Hyderabad Commission, that the respiration should be watched, is 
correct, for we believe, from a long series of observations, that grad- 
ual cardiac failure never occurs without producing respiratory changes 
from the very first. In other words, we do not believe that in a 
healthy heart chloroform can cause serious disorder without, as a 
result of beginning disorder, disturbing respiration ; and, second, 
that in the healthy heart a quantity of chloroform sufficient to disorder 
it will by its direct action disorder the respiration. If, as an extra 
precaution, one assistant watches the pulse while the other watches 
the respiration, very well, for though the respiration is the more 
important function to watch, the man watching the pulse might dis- 
cover an irregularity which the anaesthetizer may not see reproduced 
in the respiratory action ; but as divided attention generally means a 
slighting of both objects in view, Lawrie is right in insisting on the 
pulse being let alone. 

The answer to Question 3 is that death is always due in the healthy 
person to vasomotor failure accompanied by respiratory depression, 
the vascular relaxation being severe enough to cause death, even if 
artificial respiration is used skilfully. 

The answer to Question 4 is, Yes. The physician having a case of 
heart disease requiring surgical interference, should always advise the 
patient of the danger of any anaesthetic, and he should remember, 
whether it is wise to tell the patient or not, that anaesthesia always 
means a step toward death, even in the healthiest of men. In the event 
of a death under chloroform the physician is not to blame if he has taken 
proper preliminary precautions and given the chloroform properly. 

To Question 5 we have several answers to make : 

1, Chloroform may be used in hot climates (when ether is inap- 



168 DRUGS. 

plicable), where a free circulation of air increases the safety of the 
patient. 

2. Chloroform may be used whenever a large number of persons 
are to be rapidly anaesthetized, so that the surgeon may pass on to 
others and save a majority of lives, even if the drug endangers a few, 
as on the battle-field, where only a small bulk of anaesthetics can be 
carried. 

3. Its employment is indicated in cases of Bright's disease requir- 
ing the surgeon's attention, owing to the fact that anaesthesia may be 
obtained with so little chloroform that the kidneys are not irritated, 
whereas ether, because of the large quantities necessarily used, would 
irritate these organs. Quantity for quantity, ether is, of course, the 
less irritant of the two. 

4. In cases of aneurism or great atheroma of the blood-vessels, 
where the shock of an operation without anaesthesia would be a greater 
danger than the use of an anaesthetic, chloroform is to be employed, 
since the greater struggles caused by ether and the stimulating effect 
which it has on the circulation and blood-pressure might cause vas- 
cular rupture. 

5. In children or adults who already have bronchitis, or who are 
known to bear ether badly, or, in other words, have an idiosyncrasy 
to that drug, chloroform may be employed. 

Other indications for the use of chloroform in preference to ether 
are in the performance of brain surgery, where ether is apt to pro- 
duce meningeal congestion by vomiting. In performing tracheotomy, 
if the case is urgent and the ether produces respiratory irritation, 
chloroform may be used with advantage. 

Chloroform inhalations have been recommended in excessive chorea 
and in pueiyeral convulsions, and are, of course, of great service in 
the reduction of hernia, owing to the muscular relaxation produced. 

Sometimes a few whiffs will put a nervous patient to sleep, but its 
use as a hypnotic is very dangerous, as it may produce a habit, and 
the habit is apt to end fatally. 

Parturient women seem able to take chloroform with more safety 
than other women. There are four important factors in increasing 
the safety of chloroform in this class of cases : 1st. Less chloroform is 
given than is usual in surgical operations ; 2d. The pregnancy may 
produce immunity by reason of the slight cardiac hypertrophy pro- 
duced at this time ; 3d. The absence of fright, for the woman welcomes 
the anaesthetic ; and 4th. The frequently recurring pains of labor so 
stimulate the vasomotor centre that the dominant action of chloroform 
— namely, vasomotor depression — is combated. 

In severe whooping cough a few drops of chloroform may be 
poured on the hand of the attendant and the band held before the 
child's face. While the child may at first dislike the odor of the 
drug, the relief* given soon teaches the patient its value, and he will 
ask for it when lie feels the attack coining on. If the attack is pro- 
longed and violent, tliis treatment must be used with caution, owing 
to the strained condition of the heart-muscle, which may be still 
further depressed by the frequent use of the drug. The drug should 



CHLOROFORM. 



169 



not be poured on a cloth, but on the nurse's hand. In this way too 
much of it cannot be given to the patient at one time. 

Administration. — When chloroform is given, it should be poured 
drop by drop upon a folded napkin or towel, and the cloth should 
then be held about three to six inches from the mouth and nose, so 
that the vapor ma}^ be thoroughly mixed with air in the proportion 
of 5 per cent, of vapor to 95 of air. The administration must be 
gradual, as "pushing" the anaesthetic is dangerous. 

The safest method of administration is by Lawrie's or Esmarch's 
inhaler, because these provide a free circulation of air and the atten- 
tion of the anaesthetizer is not distracted from the respiratory move- 
ment by the manipulation of complicated apparatus. 

Fig. 26. 




Esmarch's inhaler and chloroform bottle. The inhaler consists of a wire frame covered by a 

piece of thin flannel. 

The dangers of chloroform seem to be considerably decreased by 
the simultaneous administration of oxygen gas with the anaesthetic 
vapor. (For the best method of using oxygen and chloroform together, 
see Oxygen, Important.) 

The author largely agrees with Lawrie's published personal con- 
clusions, which are as follows with slight modifications : 

1. The chloroform should be given on absorbent cotton, stitched 
in an open cone or cap. 

2. To ensure regular breathing, the patient, lying down, with 
everything loose about the neck, heart, and abdomen, should be made 
to blow into the cone, held at a little distance from the face. The 
right distance throughout the inhalation is the nearest which does not 
cause struggling or choking or holding of the breath. 

3. The administrator's sole object while producing anaesthesia is 
to keep the breathing regular. As long as the breathing is regular 
and the patient is not compelled to gasp in chloroform at an abnormal 
rate, there is comparatively little danger. 



170 



DRUGS. 



4. Irregularity of the breathing is generally caused by insufficient 
air, which makes the patient struggle or choke or hold his breath. 
There is little or no tendency to either of these untoward events if 
sufficient air is given with the chloroform. If they do occur, the cap 



Fig. 27. 




Lawrie's collapsible inhaler, made of four small pieces of bamboo covered with muslin. The 
chloroform may be dropped on the sides of the inhaler. 

must be removed, and the patient allowed to take a breath of fresh 
air before the administration is proceeded with. 

5. Full anaesthesia is estimated by insensitiveness of the cornea. 
It is also indicated by stertorous breathing or bj relaxation of the 



Fig. 28. 




Krohnc and Seaeman's modification of Lawrie's inhaler, with feather respiration-indicator 
attached. The inner lining is of white felt, the outer case is of leather. The chloroform 
may be poured on the felt through a small hole in the leather on the top of the inhaler. 

muscles. Directly the cornea becomes insensitive or the breathing 
becomes stertorous the inhalation should be stopped. The breathing 
may become stertorous while the cornea is still sensitive. The rule to 



CHLOROFORM. 171 

stop the inhalation should, notwithstanding, be rigidly enforced, and 
it will be found that the cornea always becomes insensitive within a 
few seconds afterward. 

Above all things, it is necessary to remember the fact that a person 
having taken chloroform twenty times before does not show he is not 
in danger on taking it the twenty-first time, and it is also to be borne 
in mind that many of the sudden deaths from chloroform have occurred 
during the first stage of the inhalation of the drug, before conscious- 
ness has been lost, and, therefore, when an accident was least expected. 

In operations about the mouth chloroform may be employed by 
passing a soft catheter through the nose and then by means of a 
hand-bulb attached to a small wash-bottle of chloroform or by means 
of a Junker inhaler introducing into the post-nasal spaces chloroform 
vapor mixed with air. 

It is often a good plan to give atropine or suprarenal gland, pre- 
ferably the former, before using chloroform, in order to avoid, if pos- 
sible, vascular relaxation. 

Persons who are robust and strong, and who struggle violently, 
are in greater danger from the use of chloroform than the sickly 
and weak, probably because the struggles cause very deep inhalations 
of the drug, exhaust the vasomotor system, strain the heart, and tend 
to dilate its walls. 

The question has arisen a number of times whether it is possible to 
chloroform a person who is asleep without his being wakened. This 
has been decided by numerous tests to be possible, particularly if the 
sleep be heavy. 

Chloroform, when taken internally by the mouth, causes a sensa- 
tion of warmth in the stomach and a hot, burning taste about the lips 
and buccal mucous membrane. In overdose it can and has produced 
death when taken in this manner. Although rarely used in internal 
medicine, chloroform in the form of the spirit of chloroform (Spiritus 
Chloroformi, IT. S.) or water of chloroform (Aqua Chloroformi, U. 8.) 
is useful in cough mixtures, which are given to persons having an irri- 
tative cough, and in cases where, through nervousness or other cause, 
tickling in the throat or bronchial tubes keeps the patient continually 
in a state of unrest. (See Bronchitis.) 

In gastric or intestinal flatulence 1 or 2 minims (0.06-0.10) of 
pure chloroform, or 10 to 20 minims (0.6-1.3) of the spirit of chloro- 
form, will often give relief. The following prescription is very useful 
in all forms of abdominal pain and is harmless in ordinary dose : 

R. — Spt. chloroformi fjfss (15.0). 

Spt. camphorse f.^ij (8.0). 

Spt. lavandul. comp q. s. f 3 iij (90.0). — M. 

S. — Dessertspoonful (8.0) in water every twenty minutes for 4 doses. 

In the treatment of serous diarrhoea the spirit of chloroform when 
combined with astringents and opium is most useful, provided that the 
irritating cause is first removed. In renal or hepatic colic a few 
inhalations, not sufficient to disturb consciousness, will not only give 
temporary but sometimes permanent relief by relaxing spasm. Hypo- 
dermic injections of 10 to 15 drops (0.65-1.0) of pure chloroform, 



172 DMUGS. 

reaching down to a painful sciatic nerve, have been recommended by 
Bartholow. This is a very painful treatment, and may cause a slough. 
Rubbed on the chest in the form of chloroform liniment, this drug will 
sometimes prevent asthmatic attacks, but chloroform ought not to be 
inhaled, except most carefully, in this disease, because of the strained 
condition of the right side of the heart. In drachm (4.0) doses chloro- 
form has been used as a remedy for tapeworm, but ought never to be 
so employed. 

When placed in liniments of a stimulating character chloroform is 
a very useful application over muscles affected by soreness and stiff- 
ness, as in lumbago and gout, and chloroform liniment may also be 
used over neuralgic areas for its local anaesthetic effect. 

Contraindications. — Chloroform is not to be used in cases of fatty 
heart or dilatation of the heart, in those with a known idiosyncrasy, 
nor in so-called lymphatic persons with overgrowth of lymphoid tissues, 
as, for example, adenoids. In the latter class it is particularly apt to 
cause sudden death. 

In the presence of valvular disease of the heart chloroform may be 
used with caution, although ether is far preferable. Given a case of 
valvular disease that must be subjected to operation, the chances are 
bettered with an anaesthetic than without it, as the pain and mental 
shock are worse for the heart than is the anaesthetic. 

Fig. 29. 




Showing the attitude in which the head should he held to permit the easy passage of air 
through the glottis. This position raises the epiglottis, and lifts the soft palate from the 
tongue. (Martin and Hare's method.) 

Untoward Effects and their Treatment. — Alarming effects produced 
Sy this drug are far more apt to appear in males than in females; the 
relative proportion being about 6 to 1. Sometimes during the adminis- 
tration of chloroform the heart or respiration suddenly ceases, and in 
some cases this change is preceded by a peculiar shade or cloud which 
passes over the face of the patient, but death may come suddenly and 
without warning. If untoward effects appear, the anaesthetic must be at 
once withdrawn and artificial respiration resorted to. Injections of ether 
and hot brandy should be given beneath the skin, and the poles of a 



CHLOROFORM. 



173 



battery with a rapidly interrupted current sivept over the body, but not 
held over the phrenic nerve or diaphragm. 1 The patient must be held 
head downward, so that the blood will 'flow to the brain, as Leonard 



Fig. 30. 




Showing the inversion of the patient as adopted by Kelly, and the method of performing 
artificial respiration simultaneously. The chest is expanded by drawing its lower seg- 
ment toward the operator. 



Hill and the author have shown that the chief cause of death is vaso- 
motor relaxation with accumulation of all the blood in the abdominal 
vessels. Bandages should be applied to the limbs and compression by 

1 While few text-books give any specific directions concerning the practical appli- 
cation of the methods which are to be employed in such emergencies, those that do so 
force the physician to a procedure at once dangerous and impractical ; for the direc- 
tions usually given are, to place the positive pole of the battery on the phrenic nerve 
as it crosses the anterior scalene muscle at the root of the neck, the negative pole 
being pressed against the lower margin of the ribs.^ A rapidly-interrupted current is 
now to be used with the purpose of causing contraction of the diaphragm by the direct 
action of the electricity upon the nerve. Even theoretically this is a possible source 
of danger, and practically the writer has proved danger to be ever present under such 
treatment. The cardiac inhibitory nerves run so closely to the phrenic fibres, and 
respond so readily to electrical stimulation, that it is hard to imagine how they can 
escape stimulation if a current be used of sufficient strength to excite the phrenic 
nerves near by. By practical experiment the writer has proved that inhibition of the 
heart may not only be possibly brought about by this method, but that it is nearly 
impossible to avoid such an effect if the phrenics are to be reached at all. 



174 



DR UGS. 



means of a bandage and large compress be exercised on the abdominal 
contents, and active artificial respiration practised for a long period of 
time as the most important measures for the patient's relief. External 
heat should be applied. Atropine, strychnine, and digitalis may be used 
to stimulate the heart and respiration. Of these, strychnine is "the most 
valuable. (See directions under the article on Ether.) Adrenalin 
chloride given hypodermically is also of value. , 



Fig. 31. 




Same as Fig. 30, except that the floating ribs are compressed to expel the air from the chest. 



In . some cases, with the movements of artificial respiration an 
assistant may grip the tip of the tongue with a pair of forceps and draw 
it out of the mouth and upward from ten to fourteen times a minute, 
in order to stimulate the diaphragm. (See Asphyxia, Part IV., for 
detailed directions for resuscitation.) In a certain number of cases 
patients apparently dead from chloroform have been resuscitated by 
repeated compression or massage of the preecordium. 

The measures adopted for resuscitation should not be stopped for 
at leasl one hour, as persons have recovered as long as tins after an 
accident from chloroform. 

Ostertag has found that very prolonged inhalations of chloroform 
in the lower animals produce widespread Catty degeneration. 



CHLOROFORM. 175 

Before closing the consideration of the use of chloroform for anaes- 
thetic purposes mention should be made of the so-called anaesthetic 
mixtures. Of these the A. C. E. is the best known. It consists in a 
mixture of 1 part alcohol (sp. gr. .838), 2 parts of chloroform (sp. gr. 
1.497), and 3 parts ether (sp. gr. .735). Billroth's A. C. E. mixture is 
composed of chloroform 3 parts, and ether and alcohol 1 part each. 
The Vienna mixture consists in 1 part of chloroform and 5 of ether, and 
the so-called methylene mixture is 30 per cent, methylic alcohol and 
70 per cent, chloroform. The object of all these mixtures is evident — 
namely, to get the anaesthetic effect of the ether and chloroform without 
the cardiac and respiratory effects of either, and the alcohol when 
added is to act as a stimulant. As the volatility of each ingredient 
varies, the mixture is useless, for the ether evaporates first, and the 
chloroform next, and the alcohol last. The A. C. E. is popular in Eng- 
land, but not so in the United States. 

The rapidity with which any drug, which produces anaesthesia 
by being inhaled, acts is governed in part by its boiling- or most 
rapid evaporation-point. The higher this point the greater is its 
rapidity of action and the more prolonged its effects. Thus we find 
that in the case of chloroform, the evaporation-point of which is 65° 
C, anaesthesia speedily follows its administration in small amounts 
and lasts for some time. Once in the system it is eliminated slowly, 
because the bodily heat is less than its point of most rapid evaporation. 
On the other hand, sulphuric ether boils at 34° C, and for this reason 
acts more slowly and more transiently, because for every breath of 
ether vapor which is inhaled an equal quantity of ether is exhaled ) 
since its evaporation-point is less than that of the body. Schleich has 
found that if chloroform, sulphuric ether, and petroleum ether are 
mixed, they form a fluid the evaporation-point of which varies from 
38° C. to 42° C, according to the proportions of the ingredients. 
By the use of such a fluid for anaesthetic purposes we avoid the over- 
effects of chloroform when used alone and the necessity of using 
excessive amounts of ether, and the patient speedily returns to con- 
sciousness after the inhalation ceases. Further disagreeable after- 
effects are said to be not so common or severe as with a single drug. 
These so-called mixtures of Schleich may be made in three ways : 

No. 1 is composed of: 

Chloroform 45 parts. 

Petroleum ether 15 " 

Sulphuric ether 180 " 

The boiling-point of this mixture is. 38° C, and as the lower the 
boiling-point the more transient the anaesthesia, it is to be employed 
in brief operative procedures of about twenty minutes. About 1 ounce, 
or 30 grammes, will be required, given best in an ordinary ether cone, 
made of cardboard and a towel. About three ounces will be needed 
for a period of one hour. If a more prolonged and powerful effect is 
desired, then one of the following mixtures is used, No. 3 being 
naturally more powerful than No. 2, because its boiling-point is 
higher, 



176 DRUGS. 

No. 2: 

Chloroform 45 parts. 

Petroleum ether 15 " 

Sulphuric ether 150 " 

The boiling-point of this mixture is 45° C. 
No. 3 : 

Chloroform 30 parts. 

Petroleum ether 15 " 

Sulphuric ether 80 " 

The boiling-point of this mixture is 42° C. 

The petroleum ether has no deleterious effects, and seems to modify 
the effect of the chloroform and dilute the sulphuric ether without 
altering its general influence. It is to be remembered that only 
petroleum ether, which boils at 60° to 65° C, is to be used. The 
ordinary petroleum ether, or benzine, of the drug stores, which boils 
at 55° C., is not suitable. 

Aside from the disagreeable odor of the benzine, these mixtures 
are said to cause less cyanosis, less mucous secretion, and other disa- 
greeable effects than any single anaesthetic known and to be safer 
in every way. 

These mixtures have not proved popular in America, and are being 
used less and less. 

Local Use and Internal Administration. — The official preparations of 
chloroform are a liniment {Linimentum Chloroformi, U. S. and B. P.); 
a water (Aqua Chloroformi, V. S. and B. P.), dose \ to 2 ounces (15.0- 
60.0) ; a spirit (Spiritus Chloroformi, V. S. and B. B.), the dose of which 
is 20 minims to 1 fluidrachm (1.3-4.0) ; and an emulsion (Emulsum 
Chloroformi, U. #.), composed of chloroform, gum tragacanth, oil of 
almonds, and water, given in the dose of 2 to 4 fluidrachms (8.0- 
15.0). The B. P. recognizes, besides those given, the Tinctura Chlo- 
roformi et Morphince Composita, dose 5 to 10 minims (0.3-0.65). 

CHROMIC ACID. 

Chromic Acid (Acidum Chromicum, U. S. and B. P.) is not a 
true acid, but an anhydride, and occurs in the form of brilliant red 
crystals, which are deliquescent and possess a sour, metallic taste. 
The acid should be kept in glass-stoppered bottles. It should never 
be mixed with sweet spirit of nitre, strong alcohol, or glycerin, or 
any organic matter, as under these circumstances it may explode. 

Therapeutics. — Chromic acid is used solely as a caustic for the 
removal and destruction of growths on the skin or mucous membranes. 
When a limited area is to be affected, a small crystal is placed on the 
part to be cauterized; but if a larger space is to be attacked, and very 
severe action is needed, the liquid resulting from its deliquescence on 
exposure to the air may be employed by means of a glass rod. The sur- 
rounding tissues should always be protected by lard or adhesive strips. 

Dr. J. Win. White lias recorded a death from the application of 
this acid to ;i large number of condylomata about the buttocks and 
vulva. Where the drug has been swallowed the patient should be 



CHR YSAROBIN-CIMICIFUGA. 1 77 

treated for gastro-enteritis, and dilute alkalies and lime-water be used, 
as well as emetics and demulcent drinks. 

If a superficial action is desired, a solution containing 100 grains 
to the ounce (6.5 : 32.0) of water is sufficient, and for small warts and 
similar growths this solution will be found strong enough. 

Liquor Acidi Chromici, B. P,, is composed of 1 part of acid to 3 
of water. 

CHRYSAROBIN. 

Chrysarobin (Chrysarobinum, U. S. and B. P.) is a mixture of 
the proximate principles derived from a powder found in the wood of 
the tree Andira Araroba, which was originally used for medicinal 
purposes in Brazil. In the East Indies it is called " Goa powder." 
Chrysarobin is sometimes misnamed chrysophanic acid, and is a yel- 
low, tasteless powder, soluble in solutions of alkalies, in acids, and 
in ether. 

Therapeutics. — Chrysarobin is given internally in the dose of ^ of 
a grain (0.008) in psoriasis and parasitic diseases of the skin, but 
more commonly is employed externally in the form of the official 
ointment (Unguentum Ohrysarobini, U. S. and B. P.), which is too 
strong for direct use, and should be mixed with 4 or 5 parts of ben- 
zoated lard before application to the skin. Even when so diluted 
chrysarobin may cause great swelling and inflammation of the skin, 
with desquamation of the cuticle. Should the surface be broken, it 
may be absorbed and cause vomiting. As the drug stains the skin 
a dark-brown, it ought not to be used on the face, but should this acci- 
dent occur the discoloration may be removed by the application of a 
weak solution of chlorinated lime. In psoriasis the following may be 
employed after the patient has taken a bath to soften the scales : 
R.— Chrysarobini .-..." 3J (4.0). 

ShoL} aaq.s.utft.soi. 

Collodii f jfij (60.0).— M. 

S. — Apply to the part affected with a brush. 

CIMICIFUGA. 

Cimicifuga ( U. S.). — This drug is derived from Cimicifuga Race- 
mosa, otherwise known as black cohosh or black snake-root. It con- 
tains a resin and a volatile oil, upon which its medicinal powers are 
supposed to depend. The fluid extract and tincture should always be 
freshly prepared from the fresh crude drug. It is official in the B. P. 
as Cimicifugw Rhizoma. 

Physiological Action. — In very large doses cimicifuga paralyzes the 
sensory side of the spinal cord of the lower animals, and in consequence 
lowers reflex activity, It has no effect on the nerves and muscles. 
On the circulation the drug acts by depressing the heart and vasomotor 
system. Death is due to respiratory arrest. In small dose it is a 
feeble cardiac stimulant. When full medicinal doses are given to man 
it nearly always produces frontal headache. Its known physiological 
effects have no direct bearing upon its use in medicine. 

12 



178 DRUGS. 

Therapeutics. — Cimicifuga is, after arsenic, the best remedy we 
have for chorea, particularly if the patient is otherwise in good health, 
but it should be used with careful attention to the regularity of the 
bowels and often be accompanied by iron. It is also indicated where 
there is, in addition to St. Vitus's dance, a rheumatic tendency. In 
chronic bronchitis it is asserted to be of value, and in rheumatism of a 
subacute or chronic type cimicifuga sometimes gives relief. 

(Jfmicifuga has been highly praised in the treatment of neuralgia, 
particularly of the ovarian type, and in amenorrhoea, subinvolution, 
and tenderness of the womb. To women who state that they cannot 
step off a step without paining or hurting the uterus or ovaries cimi- 
cifuga often gives relief. Some writers assert that it is an efficient 
heart tonic in cases of fatty and irritable heart when digitalis fails. 
There can be no doubt that it is a powerful uterine stimulant, and it 
ought to be used with care during pregnancy for fear of abortion. 
There are, however, some practitioners who commend its use for the 
prevention of this accident. By reason of this power it may be 
employed instead of ergot during labor, and is said to be better in 
some cases, because it produces normal, not tonic contractions. As a 
matter of fact, it is little used for this purpose. In the treatment of 
headache arising from overstraining of the eyes in study cimicifuga is 
said to do good. 

The drug is official as the extract (Extr actum Cimicifugce, U. S.), 
close 1—5 grains (0.5-0.3), the fluid extract (Extractum Cimicifugce 
Fluidum, U. S., or Extractum Cimicifugce Liquidum, B. P.), the dose 
of which is 10 to 30 minims (0.65-2.0) or even 1 drachm (4.0), and 
the tincture (Tinctura Cimicifugce, U. S. and B. P.), the dose of 
which is 1 to 2 drachms (4.0-8.0). 

CINCHONA. 

Cinchona, U. S., is a name applied to the bark of all the trees 
belonging to the genus Cinchona, provided they contain as much as 
2.5 per cent, of the alkaloid quinine, or 5 per cent, of total alkaloids. 
There are thirty-one species of this genus, but only a comparatively 
small number can be included in the list of those which contain 5 per 
cent, of alkaloid. These are the Cinchona Calisaya, or Cinchona 
flava, which contains the most quinine, the Cinchona Condaminea, 
Cinchona Micrantha, Cinchona Succiruba, or Cinchona Rubra, U. 8., 
Cinchona? Rubrm Cortex, B. P., and Cinchona Pitayensis. The first 
is called yellow bark, the second pale bark, the fourth red bark. The 
alkaloids of the quinine series derived from these barks are quinine or 
quinina, quinidine or quinidina, and quinicine, which is an artificial 
alkaloid. Of the cinchonine series we have cinchonine, cinchonidine, 
and cinchonicine, which last is also an artificial alkaloid. Besides 
these alkaloids we have present kinic and kinovic acids and other inert 
mid useless substances. 

As (|iiinme is the most important of the group, and as its physio- 
logic;! I action is virtually identical with the rest, whatever is said 
hereafter in this article refers to quinine, unless it is otherwise stated. 



CINCHONA. 179 

All the alkaloids of cinchona which have been named are not employed 
as pure alkaloids, but as salts formed by adding sulphuric, hydrochloric, 
or other acid to increase their solubility. 

Physiological Action. — When quinine is taken in overdose it causes 
ringing in the ears, dizziness., disorders of taste and smell, disturbance 
of vision in some cases, and fulness in the head. Deafness often comes 
on, and is generally, with the roaring in the ears, the most pressing 
symptom. Headache is not uncommon. (See Untoward Effects.) 

Nervous System. — Upon the cerebrum quinine acts as a stimu- 
lant, and finally as a congestant, if given in excessive dose. If poi- 
sonous doses are used, intense cerebral congestion ensues, and finally 
unconsciousness comes on. On the spinal cord of the lower animals 
the drug first causes a decrease in reflex action by stimulating 
Setschenow's reflex inhibitory centre, and finally by depressing the 
spinal cord and nerves. The latter changes occur only after poison- 
ous doses. 

Circulation. — If quinine, even in small amount, be injected into 
the jugular vein of a dog, so that it goes in concentrated form to the 
heart, cardiac paralysis will result. If this does not occur, the drug 
simply decreases pulse-force, pulse-rate, and arterial pressure. When 
given to man in small medicinal doses by the mouth, the drug acts as a 
general stimulant to the entire body, and so tends to support the circu- 
lation, increasing to a slight degree the pulse-rate and blood-pressure. 
If the dose by the mouth be very large (15 grains), the pulse is 
depressed. Full doses in fever therefore act as vascular sedatives. 

Blood. — The blood after poisonous doses is more coagulable than 
normal, but in medicinal amounts no such effect is produced. The 
effect of quinine on the blood-corpuscles is of great interest. Even in 
full medicinal doses it arrests the diapedesis of the white cells from the 
capillaries by a direct action on these cells, and if the drug be applied 
to the mesentery of a frog the cells already extruded cease their move- 
ment, but the intravascular cells do not. On the other hand, if the 
quinine be given internally in so small a dose that the proportion to 
the blood is 1:20,000, the white cells in the vessels cease to migrate, 
but the ones in the surrounding tissues do not (Binz, Hare, Dissel- 
horst). This is perhaps the explanation of the effects of quinine in 
acute inflammations, for it arrests inflammatory exudation and allows 
the extiuded cells to wander away from the diseased area. It is stated, 
however, that this is not the case with all animals. Binz asserts that 
in the proportion of 1 : 20,000 quinine diminishes the number of white 
cells. Medicinal amounts gradually increase the number of red blood- 
corpuscles very materially in man. It is said that quinine inhibits 
the oxygen-bearing powers of the red corpuscles, but this probably 
does not occur from medicinal doses. 

Respiration. — Upon respiration quinine acts as a slight stimulant 
in small doses, but as a marked depressant in poisonous amounts, 
death being most commonly due in animals to failure of respiration if 
it be taken by the stomach in lethal dose. 

Temperature. — Quinine lowers bodily temperature in health very 
little if at all, and in fevered states its influence is governed by the 



180 DRUGS. 

cause of the fever. Thus in malarial fevers quinine is a very powerful 
indirect antipyretic, by reason of its peculiar powers over the infection, 
and not because it has any direct influence over heat production and 
dissipation. 

Absorption. — Quinine is absorbed from the stomach, not from the 
intestine, and it is precipitated by the alkaline juices of the bowel. 
For this reason it should be given in cachets, capsules, or powders, 
rather than in compressed tablets, so that it may be absorbed by the 
stomach before it reaches the intestine. If pills are used, only those 
which have been freshly made should be employed. 

Kidneys, Elimination, and Tissue-waste. — Quinine escapes 
from the body chiefly through the kidneys, although some of it is 
destroyed by oxidation in the liver and tissues. The process of 
excretion of quinine is by no means rapid, so far as the entire quan- 
tity to be eliminated is concerned. While it may in rare instances 
be found in the urine in fifteen minutes from the time it is given, it 
does not disappear from this secretion for about twenty-four hours. 
In the urine it is found as quinine and as dihydroxyl quinine. 

Upon tissue-waste quinine acts as a depressant and decreases the 
elimination of nitrogenous materials. 

Digestive Tract. — Quinine has a bitter taste in as small a pro- 
portion as 1 : 10,000 of water. Upon the stomach it acts as a tonic 
and stimulant, but if given too frequently or in large doses it may 
irritate this viscus. Moderate doses are slightly constipating in their 
effects, and very large doses may induce colicky pain. 

Poisoning and Untoward Effects. — Severe poisoning from quinine 
very rarely occurs except in persons who have an idiosyncrasy to the 
drug. Recently Roberts has recorded the case of a woman, aged 
thirty-six years, who took 5 drachms (20 grammes) and survived, after 
suffering from deep coma, shallow breathing, slow pulse, absolute deaf- 
ness, and blindness. The loss of sight lasted two weeks, but the retinal 
changes persisted for several months. Death from an overdose of 
quinine is exceedingly rare. The cases in which death has followed 
its use are medical curiosities. Bouchardat has recorded the case of an 
adult male who died as a result of taking from 45 to 65 grains of the 
drug. Whether this was the real cause of death is doubtful. Soullier 
quotes Tarnier and Budin as asserting that enough quinine may be 
eliminated by the milk to produce death in a nursling. This seems 
hardly possible. 

" Untoward effects " is the best term with which to qualify the dis- 
agreeable symptoms which sometimes come on in persons having an 
idiosyncrasy to the drug and who are in reality poisoned by small doses. 
In these cases sudden, complete, but temporary blindness is often met 
with. DeSchweinitz has shown that in dogs quinine produces in toxic 
doses constriction of the retinal arteries, thrombosis of the central vein 
of the retina, and permanent optic atrophy; and Holden has proved 
that there is degeneration of the nerve-fibres and ganglion-cell layers 
of the retina. In other instances complete deafness asserts itself, 
due to congestion of the middle ear, while skin eruptions, generally 
of the nature of erythema, are not rarely seen. In other instances 



CINCHONA. 1 81 

petechial and vesicular eruptions are developed, and swelling of the 
gums with a tendency for them to bleed may appear (Schulz). After 
lethal doses hemorrhage into the middle ear may be found, and 
severe epistaxis may ensue after so small a dose as 4 grains (0.2). 
The buzzing in the ears can generally be put aside by the adminis- 
tration of 10 grains (0.65) of bromide of sodium combined with a 
little ergot. Karamitsas has proved that quinine may produce hemo- 
globinuria in persons suffering from malarial poisoning, and apparently 
may even develop bilious remittent fever. 1 Irritability about the 
neck of the bladder may sometimes be produced by quinine. 

Therapeutics. — The drug is employed in medicine to fulfil three 
great offices, although its influence in other directions is hardly less 
powerful. These are as an antiperiodic or antimalarial, as an anti- 
pyretic, and as a tonic possessing peculiar virtues. 

For many years physicians were forced to employ this drug empiri- 
cally, not knowing the cause of the disease called malaria. We now 
know that the theory of Binz, offered as long ago as 1867, is correct, 
and that malaria is due to the presence of a germ, the plasmodium 
malarise, which was first accurately studied by Laveran and named by 
Marchiafava and Celli. These and other investigators have found that 
quinine acts as an active poison to these germs, even in so weak a solu- 
tion as 1 : 20,000. 

For the reasons given in the preceding paragraph quinine is the 
best remedy we have for malarial fever as a prophylactic and cure, 
and it should be given in doses which are indicated by the state of 
the patient. (See Malarial Fever.) If possible it should always be 
preceded by a purge having an hepatic action. This preliminary 
treatment is particularly important in bilious or remittent fever. The 
drug should be given in hourly doses, or in one or two large doses in 
such a way that its influence is fully felt, not only at the time of the 
expected paroxysm, but about an hour or thirty minutes before that 
time. If the paroxysm is near at hand, the drug should be given in 
solution, bitter though it be, in acidulated water. If the case be so 
far advanced as the sweating stage, it should be given nevertheless to 
destroy the spores just set free. (See Intermittent Fever.) 

As a prophylactic against malaria the dose of quinine should be 2 
to 4 grains (0.1-0.2) or more three times a day. 

In hemorrhagic malarial fever quinine sometimes seems to do more 
harm than good. Under such circumstances the danger in using 
quinine consists in irritating the engorged kidneys after the chill has 
passed. Quinine is not a haemostatic, and only does good in malarial 
hematuria by preventing the paroxysm which produces the bloody 
urine. In hematuria occurring in persons broken down in health 
from the results of chronic malarial infection quinine is of no value 
unless an examination of the blood reveals the presence of parasites due 
to a new infection. To give quinine after this symptom appears is 
to a lock the door after the horse is stolen" unless the parasites are 
found in the blood. Indeed, it would seem certain from the studies 

1 See collective investigation of this subject by the author in Therapeutic Gazette 
for July, 1892 ; also article in New York Medical Record, January 7, 1899. 



182 DRUGS. 

of many physicians in America, Greece, and Italy, that the use of 
quinine is capable of developing a hematuria. 1 (See Hematuria.) 
If, however, an examination of the blood reveals the malarial parasite, 
the drug should be freely used. 

In pernicious malarial fever quinine should be given by the mouth, 
by the rectum, and hypodermically, and even intravenously, as much 
as 60 to 70 grains (4.0—4.5) being used. 

In brow ague or malarial neuralgia quinine often acts most use- 
fully, and this is also true in some cases of ordinary nerve-paiu not 
dependent upon a specific disease. 

For the reduction of the pyrexia of typhus or typhoid fever quinine 
will be found inferior to the new antipyretics, even when given in very 
large dose, and it ought to be used very rarely, if at all, for this purpose. 
In all fevers it will seldom cause a fall of temperature before crisis or 
lysis, but will aid in the fall very actively after these changes have 
occurred. In those cases of fever in which the use of quinine is fol- 
lowed by marked improvement the good results are due either to its 
specific antimalarial influence or to its stimulating influence on the 
general system. 

As a tonic quinine acts not only as a simple bitter, but also seems to 
have a direct effect in increasing the number of the red blood-corpuscles. 
The tonic dose should be 1 to 2 grains (0.05-0.1) three times a day. 

Quinine has been used to overcome uterine inertia in weak women, 
but it is a feeble remedy, and is less and less resorted to by progressive 
obstetricians. (See Kola.) It will not of itself cause abortion, but 
in nervous, hysterical women who have a tendency to abort, and to 
whom it is necessary to give full doses of quinine during pregnancy, 
it may be well to combine some sedative, as one of the bromides or 
opium, with the antiperiodic. 

In the lobar pneumonia of children quinine should be used in sup- 
positories in the dose of 2 grains (0.1) three times a day. 

Acting on the basis that chorea is due to lack of inhibitory control 
of muscular movements, Wood has urged the use of quinine in large 
doses in this disease as a stimulant to inhibition. Whether the good 
which sometimes follows this treatment is due to any specific effect of 
the drug is doubtful. 

In cases where prolonged mental or physical strain is to be undergone, 
quinine in the dose of 2 to 4 grains (0.1-0.2) will often prevent exhaus- 
tion and support the system. 

The internal use of quinine is also a wise procedure in whooping 
cough, and the best dose, according to a careful series of studies by 
Baron, is If grains (0.075) to each year of the child's age, to be given 
at G a. m., 2 p. M., and 10 p. m. 

A very much more agreeable method of pursuing this treatment in 

whooping cough is to give the patient the so-called quinine chocolates, 

which are made of 1 grain (0.05) of tannate of quinine and chocolate. 

The taste of quinine in such chocolates is scarcely noticeable if they 

are well made. 

1 See collective investigation of this subject by the author in Therapeutic Gazette 
for July, L892; also article in New York Medical Record, January 7, 18D9. 



CINCHONA. 1 83 

Used in solution in the form of a spray by the atomizer, quinine is 
of undoubted service in whooping cough, and will often prevent the 
spread of the disease to other children if they be subjected to its 
use. This solution should contain from 1 to 2 grains (0.05-0.1) to the 
ounce (32.0) and be employed every few hours. It is well to remem- 
ber that quinine is not tasted by the tip of the tongue, but is tasted by 
the back portion. The tip of the atomizer should therefore be carried 
well back of the root of this organ, and a 1 per cent, solution of cocaine 
painted over the dorsum of the tongue in cases where the disagreeable 
taste of the quinine is objected to very strongly. This solution of 
quinine used, by -means of an atomizer, in colds in the head and in 
foetid sore throat is often of service. High rectal injections of 
quinine in the strength of 1 : 3000 are useful in amoebic dysentery, as 
this drug destroys the amoeba coli. 

Administration. — When prescribing quinine the physician should 
employ the hydrochlorate (Quinince Hydroc Moras, U. S. ; Quinifice 
Hydrochloridum, B. P.), as it contains a high percentage of alka- 
loid and is very soluble. An acid hydrochloride (Quinince Hydro- 
chloridum Acidum) is also official in the B. P. The hydrochlorate 
of quinine is stronger in alkaloid than the bisulphate of quinine 
(Quinina? Bisulphas, U. $.), which is, however, soluble in the pro- 
portion of about 1 to 8 of water. The hydrobromate of quinine 
(Quininae Hydrobromas, U. S.) is another useful salt, which is solu- 
ble in the proportion of 1 to 16 of water. The valerianate of quinine 
(Quinince Valerianas, U. S.) possesses no particular value. The 
sulphate of quinine (Quinince Sulphas, U. S. and B. P.), the least 
soluble of all these salts, is by custom most commonly administered. 
The tannate of quinine is a salt not so bitter as the other salts, and is 
weaker in relative alkaloidal strength. One grain (0.05) of the tan- 
nate equals about \ of a grain (0.015) of pure alkaloid. The bisul- 
phate equals about |- and the sulphate f of a grain of the pure alka- 
loid. The dose of all the salts of quinine varies from 1 to 4 grains 
(0.05-0.15) as a tonic, and from 4 to 60 grains (0.26-4.0) for anti- 
malarial purposes. 

The B. P. recognizes a pill of quinine, the Pilula Quinince Sul- 
phatis, a tincture (Tinctura Quinince), a wine (Vinum Quinince), and 
an ammoniated tincture (Tinctura Quinince Ammoniata). 

In regard to the administration of quinine, it may be said that it 
ought never to be given in solution if it can be avoided, because of its 
disagreeable taste. If. it is given in solution, the liquid should be 
well acidulated, as under these circumstances it will not taste as bitter 
as when a weakly acidulated solution is employed. In adults and chil- 
dren quinine should be used preferably in small capsules or in pills, 
which may be gelatin- or sugar-coated. Another means for adults is 
the use of cachets. If pills or capsules are employed, care should be 
taken that the sugar is not hardened by age, and that the gelatin is 
thin, for if the pill or capsule escapes into the intestine before it is 
dissolved the quinine is precipitated and is not absorbed. If the case is 
that of a child too young to take a pill, the drug may be given in the 
following manner without tasting very disagreeably : 



184 DRUGS. 

R. — Quinine hvdrochlor . . gr. xvj (1.0). 

Ext. glycyYrhiz. fl f&j (4.0). 

Syrupi aurantii cort f^ij (60.0). — M. 

S. — A teaspoonful t. d. for a child of three years. 

In some cases quinine chocolates may be used, but unless they are 
well made the after-taste of quinine is well marked. When they are 
used tannate of quinine should always be placed in them. In other 
cases quinine may be used in the suppository in the dose of 2 to 3 grains 
(0.1—0.15), care being taken that irritation of the rectum does not ensue. 
For suppositories the best salt to employ is the hydrochlorate. 

For hypodermic use the hydrochlorate of quinine should be used 
most commonly, as it is soluble in about 10 parts of water, and con- 
tains more of the alkaloid than the more soluble bisulphate of 
quinine. It may be employed in the following manner : 

R. — Quininse hydrochlorat gr. vij (0.5). 

A&T51} •••/•. *fc.(2.0).-M. 

S. — Warm solution before using it, and do not add acid. 

R. — Quininae hydrochlorat gr. xv (1.0). 

Alcoholis tt^xv (1.0). 

Aquae dest f^jss (6.0).— M. 

S. — Add a few drops of hydrochloric acid to complete the solution before using. 

If the bisulphate is used hypodermically, to its solution should be 
added a little tartaric or sulphuric acid to prevent precipitation of the 
drug in the alkaline juices of the connective tissues before it can be 
absorbed. The tartaric acid should be present in the proportion of 
about 1 grain (0.05) to each 5 grains (0.3) of the quinine. Should it 
be necessary to use the sulphate of quinine hypodermically, 10 grains 
(0.65) should be added to 1 drachm (4.0) of water and sulphuric acid 
added, drop by drop, until the salt is dissolved. The hydrobromate of 
quinine, the solubility of which is about 1 to 54 of water, may also be 
used hypodermically, as may also the bimuriate of quinine and urea 
(Quinince Bimuriatica Carbamas), which, however, is scarcely more 
than half as strong in quinine as the other salts. 

The best place to give the hypodermic injection is in the buttock, 
between the trochanter and the tuberosity of the ischium. Injections 
into the calf of the leg are very painful. 

In Italy, Baccelli has resorted to the intravenous injection of qui- 
nine in pressing cases of malarial infection. He employs the following 
solution for this purpose: 

R.— Quininse hydrochlorat gr. xv (1.0). 

Sodii chloridi gr. xv (1.0). 

Aqua? dest f^ijss 1 10.0).— M. 

S.— This should he injected, after an ounce (30.0) of distilled water has been added 
to it. The solution should he boiled and filtered, and used while warm. 

As quinine in a concentrated form is a powerful heart-depressant, 
the drug should be injected very slowly indeed into a vein of the Leg 
when intravenous injections are employed. 



CINNAMON. 185 

The alkaloids of cinchona other than quinine which are commonly 
used in medicine are cinchonidine, cinchonine, quinidine, and the im- 
pure substance chinoidinum. 

Cullen, Sinkler, and De Brun have all found the sulphate of cin- 
chonidine (Cinchonidina Sulphas, U. S.) very useful in malaria, and 
it is less bitter and more soluble than is quinine. Sinkler states that 
it does not produce the severe head-symptoms caused by quinine. 

The dose of quinidine sulphate (Quinidino? Sulphas, U. S.) is about 
twice that of quinine, as is also that of cinchonine sulphate (Cinchonina? 
Sulphas, U.S.) and cinchonidine sulphate (Cinchonidina Sulphas, U.S.). 

Chinoidinum is a resinous mass obtained in the preparation of the 
alkaloids of cinchona, and contains amorphous .alkaloids. It possesses 
distinct antiperiodic power, and was used freely when quinine was a 
very expensive drug. Its dose is three or four times that of quinine. 

The liquid preparations of cinchona are the infusion (Infusum Cin- 
chona?, U. S.), dose a wmeglassful (32.0) ; the tincture (Tinctura Cin- 
chona?, U. S. and B. P.), one or two teaspoonfuls (4.0-8.0) ; and the 
compound (Huxham's) tincture (Tinctura Cinchona? Composita, U. S. 
and B. P.), a teaspoonful to a tablespoonful (4.0-15.0). Huxham's 
tincture is a most efficient and elegant bitter tonic in debility and con- 
valescence from low fevers. It is too weak in alkaloids to be used in 
malarial poisoning. Under the name of elixir roborans, or Whytt's 
tincture, a similar mixture is employed for precisely the same purposes. 
The other liquid preparation is the fluid extract (Extractum Cinchonce 
Fluidum, U. S., or Extractum Cinchona? Liquidum, B. P.), dose 5 
to 15 minims (0.3-1.0). A solid extract (Extractum Cinchonce, U. S.) 
is also official, and is given in the dose of 5 to 10 grains (0.3-0.65). 
The B. P. preparation not official in the U S. P. is the Infusum 
Cinchona? Acidum, dose 1 to 2 fluidounces (30.0-60.0). 

Contraindications. — Quinine is contraindicated in gastritis, cystitis, 
meningitis, epilepsy, cerebritis, middle-ear disease, because it congests, 
irritates, or stimulates those areas which are diseased, and in those cases 
which have an idiosyncrasy to its action. 

CINNAMON. 

Cinnamon (Cinnamomum Cassia vel saigonicum vel zeylanicum, 

U. S., Cinnamomi Cortex, B. P.) is the inner bark of a plant, a 

native of Ceylon or of the species indigenous to China. It contains 

a volatile oil and tannic acid. In overdose the oil acts as a soporific 

and kills by failure of respiration. 

Therapeutics. — Cinnamon is used, as are all the drugs of its class, 
for flavoring, as a carminative, and as an intestinal stimulant in serous 
diarrhoeas. It has the peculiar power of acting as a haemostatic in 
uterine hemorrhage where the flow is oozing and not active, thereby 
differing from the other volatile oils, with the exception of that of 
erigeron. The oil of cinnamon is a powerful antiseptic, which can be 
used in dilute form in the dressing of wounds and by injection in 
gonorrhoea. J. Chalmers DaCosta employs a spray of oil of cinnamon 
and benzoinol in the proportion of 1, 2, or 3 minims (0.05-0.15) of 



186 DRUGS. 

the oil to 1 ounce (30.0) of benzoinol, or it may be used by injection. 
It seems to act best in the early stage of gonorrhoea. 

Cinnamic acid, a derivative of oil of cinnamon, is also used for the 
same purposes ; but its chief employment has been in the treatment of 
tuberculosis. This consists in injecting hypodermically and intra- 
muscularly 2 minims (0.1) of the acid. This produces burning pain, 
which soon disappears. The patient, however, feels fatigued, has 
vertigo and cerebral congestion. Gradually the dose is increased to 
15 minims (1.0), and after several weeks the patient is said to cough 
less, to gain in weight, and to improve in his physical signs. The 
treatment is so painful that it has not gained many friends. 

Administration. — The dose of the oil (Oleum (Knnamomi, U. S. 
and B. P.) is 1 to 5 minims (0.06-0.3); of the water (Aqua Cinna- 
momi, U. S. and B. P.), a wineglassful (30.0) or less; of the spirit 
(Spiritus Cinnamomi, U. S. and B. P.), 5 to 30 minims (0.3-2.0); 
of the tincture (Tinctura Cinnamomi, U. S. and B. P.), J to 1 drachm. 
Under the name of Pulvis Aromaticus, U. S. {Pulvis Cinnamomi 
Compositus, B. P.) a carminative powder, consisting of cinnamon 
35 grams, nutmegs 15 grams, cardamoms 15 grams, and ginger 35 
grams, is official. The B. P. preparation does not contain nutmeg. 
It is useful in the treatment of the flatulence of adults and children. 
The latter should take about 10 grains (0.65) at a dose, an adult 30 
grains (2.0). 



CITRIC ACID. 

Citric Acid (Acidum Citricum, U. S. and B. P.) is chemically iden- 
tical with the acid of the lemon, but has not identical influences over 
the body with lemon-juice. 

Not only does the lemon owe its acidity to this acid, but most of 
the other edible fruits, such as strawberries and raspberries, depend 
upon its presence for their acidity. 

Therapeutics. — Citric acid is used in scurvy, or scorbutus, as a pro- 
phylactic and cure. For some unknown reason, pure lemon-juice 
seems to benefit these cases more than citric acid itself, and it is there- 
fore to be preferred to the latter whenever it can be had. In order 
to keep lemon-juice from decomposition on long voyages, it should be 
boiled, and poured while hot into bottles until it nearly reaches to the 
cork ; the remaining space is then filled with a thin layer of sweet oil 
and the bottle corked and stood upright. Under these circumstances 
the juice may be kept indefinitely. 

In rheumatism, either acute or chronic, lemon-juice may be em- 
ployed in the dose of 1 to 2 ounces (32.0-64.0) four times a day, well 
diluted, or 2 drachms (8.0) of citric acid may be given. The acid is 
also <>f value in hepatic inactivity and catarrhal jaundice. (See Citrate 
of Potassium.) 

The preparations containing citric acid are Syrupus Acidi Citrici, 
U. S., Succus Limonis, B. P., and Syrupus Limonis, B. P. 



CLOVES— COCA AND COCAINE. 187 

CLOVES. 

Cloves (Caryophyllus, IT. S.; Caryophyllum, B. P.) are the unex- 
panded flowers of the Eugenia aromatiea, a plant of the East and 
West Indies. They possess an aromatic odor and the pungent taste 
of a typical spice. They contain a volatile oil (Oleum Caryophylli, 
TJ. S. and B. P.), which is yellow when fresh, but very dark-colored 
when old. 

Therapeutics. — Cloves or their oil are used in medicine for the pur- 
pose of exercising a carminative influence. They are also employed 
as a stimulant and tonic to the stomach to prevent griping during an 
attack of diarrhoea, or that caused by purgatives, to act as a flavoring 
agent, as a counter-irritant, and, finally, as a parasiticide and local 
anaesthetic. 

The oil of cloves possesses great power for good in many cases of 
pulmonary tuberculosis, partly by its germicidal influence upon the 
bacillus. It should be given in the dose of 5 minims (0.3) in capsules 
after food three or four times a day, and a hypodermic injection of ster- 
ilized sweet oil, containing in each dose of 30 minims (2.0) 5 minims 
(0.3) of the oil of cloves, should be administered once a day. The 
injection should be given into the subcutaneous tissues of the flank or 
abdomen, and is painful, but the decrease in the cough and expectora- 
tion amply repays the patient for the pain. 

Like all volatile oils, this oil is an efficient local application for 
pediculus pubis and similar parasites. It may be used in toothache, 
because of its anaesthetic powers, if placed on a pledget of cotton in 
the cavity of the aching tooth. In the treatment of myalgia or mus- 
cular rheumatism oil of cloves is often placed in a liniment for its 
counter-irritant eifect. Minute doses of \ to 1 minim (0.03-0.06) of 
the oil in a little water will sometimes control excessive vomiting. In 
addition to the oil the B. P. has an official infusion, Infusum Cary- 
ophylli, the dose of which is 1 to 2 fluidounces (30.0-60.0). 

In overdose it acts as a soporific, and kills by failure of respiration 
and the production of marked gastro-enteritis. 

COCA AND COCAINE. 

Coca is official in the TJ. S. P. as Coca, and as Cocas Folia in the 
B. P. ; but in the TJ. S. P. of 1880 it was known as Erythroxylon. 
Cocaine, Cocaina (B. P.) (Cocaina? Hydrochloras, TJ. S. ; Cocaince 
Hydrochloridum, B. P.) is the alkaloid derived from Erythroxylon 
Coca, which is a shrub of Peru and Bolivia. When cocaine is heated 
with hydrochloric acid it is split up into several substances, amongst 
others a base called ecgonine, which has entirely different powers from 
cocaine, and is perhaps responsible for some of the evil effects which 
have resulted from poorly prepared cocaine. It is to be distinctly 
understood that Erythroxylon Coca is not the same as chocolate or 
Theobroma Cacao. 

Physiological Action. — Coca and its alkaloid cocaine, when taken 
internally, produce a sense of exhilaration and pleasure. Often the 



188 



DRUGS. 



Fig. 32. 




A, Sensory nerve supplying mucous 
membrane B, , which is anaesthe- 
tized by cocaine paralyzing the 
ends of the sensory nerve at B. 



amount of muscular and mental power is temporarily increased under 
their influence. When locally applied to a mucous membrane, cocaine 
causes a blanching followed by marked congestion. 

Nervous System. — The dominant action of cocaine, when locally 
applied to the peripheral sensory nerves, is to paralyze them (Fig. 32). 

When taken internally it stimulates the 
brain to an extraordinary degree, but ex- 
ercises no effect upon the sensory nerves. 
Sometimes its internal use produces a de- 
crease of sensation, which Mosso believes 
to be due to an influence on the spinal 
cord. This effect is, however, very fee- 
ble. If the dose be a poisonous one, con- 
vulsions of cerebral origin ensue, and are 
both clonic and tetanic in type. 

The sensory nerves are paralyzed by 
enormous doses both when the drug is 
directly applied and when it is taken 
internally. 

Upon the muscles, when taken inter- 
nally, Mosso has proved the drug to be a 
direct stimulant, and it is particularly 
active after starvation or fatigue. Mus- 
cular power is increased temporarily by 
cocaine. 

Circulation. — Cocaine acts as a stim- 
ulant to the heart and circulation in moderate amounts, but its effects 
are not marked except in poisonous dose. 

Respiration. — The drug acts as a powerful respiratory stimulant, 
producing in large dose a great increase in the rapidity of the respira- 
tory movements, but in poisonous dose it kills by failure of respira- 
tion associated with exhaustion from the accompanying convulsions. 

Temperature. — Cocaine raises bodily temperature to a very 
extraordinary degree if given in overdose, this rise being due to an 
increase of heat-production (Reichert). In moderate or medicinal 
amounts it has no effect. 

Kidneys, Elimination, and Tissue-waste. — The drug is elimi- 
nated by the kidneys, but is chiefly destroyed by oxidation in the 
body. The quantity of urine passed is increased under its influence, 
and the nitrogenous elements eliminated in this fluid are a little 
diminished. 

Eye. — Owing to its powerful action as a local anaesthetic, cocaine 
has been used largely in diseases of the eye, and it is particularly effi- 
cacious in this organ because of the delicacy of the conjunctiva, which 
it can readily penetrate and so paralyze the peripheral sensory nerve- 
endings. The anaesthesia comes on in from oik? to five minutes after 
the use of the drug, according to the strength of the solution used. It 
is accompanied by very marked dilatation of the pupil, which Roller 
asserts is due to the fact thai the drug constricts the blood-vessels of 
the iris but leaves the muscular fibres untouched. Ophthalmologists, 



COCA AND COCAINE. 189 

however, generally assert that it stimulates the peripheral ends of the 
sympathetic nerve. It is important to remember that this dilatation, 
unlike that produced by mydriatics, such as atropine, is not accom- 
panied by paralysis of accommodation. The drug does not cause a 
forcible mydriasis, and is never used for the prevention of adhesions 
in iritis unless combined with atropine. 

Therapeutics. — Cocaine lay drocMom,te (Cocaince Ilydrochloras, U.S., 
and Cocaince hydrochloridum, B. P.) is used as an anaesthetic in the 
eye in the dose of from 3 to 5 or more minims of a 1 to a 4 per cent, 
solution. The strength of 2 and 3 per cent, is perhaps most commonly 
employed. It is worth remembering that cocaine is soluble in fats, 
whereas its salts are not. Cocaine itself should therefore be used in 
anaesthetic salves. 

The conditions indicating its use in the eye are all operations of a 
painful character, be they what they may, and it can also be used for 
the relief of pain when an acute inflammation or foreign body is caus- 
ing suffering. 

The following formula will be found useful in these states : 

R. — Cocainae hydrochlor. . . • gr. viij (0.53). 

Acid, boric gr. vij (0.46). 

Aquse dest f^j (30.0).— M. 

S. — Use with a dropper in the eye every half hour until relieved. 

Cases of keratitis are recorded in which cocaine has produced per- 
manent corneal opacities, and it may cause dryness and roughening of 
the corneal epithelium even in the normal eye. 

Cocaine is often used in 2 per cent, solution upon cracked nipples 
just before nursing, to relieve pain. The drug must be carefully washed 
off before the baby is put to the breast. It is asserted, however, by 
Guenel and Desamaux that this treatment may permanently stop the 
flow of milk. 

Owing to the density of the mucous membranes of the vagina and 
rectum, cocaine has little effect upon them unless used in 10 per cent, 
solution and profusely applied. In the mouth cocaine may be used 
in cases of stomatitis where a spot is to be cauterized, in pharyngitis, 
and in soreness and tenderness of the gums. While it gives much 
temporary relief in pharyngitis, the subsequent effects are often 
exceedingly disagreeable, the congestion looking more angry and 
being more painful than before, and the experience of the writer 
indicates that it will only act in a curative manner if applied before 
the capillaries become relaxed or paralyzed by the severity of the 
inflammatory process. In coryza and hay fever a powder consisting 
of cocaine, morphine, and bismuth in the proportion of 1 part each 
of the two alkaloids and 5 parts of the bismuth will often be of ser- 
vice if snuffed up into the nostrils. If cocaine be applied to a large 
nerve-trunk, amputation of the tributary limb may be performed with- 
out pain, but so large an amount of the drug must be used that there 
is great danger of poisoning the patient. 

Cocaine is generally used at present in the place of ether in cases 
requiring amputation of the fingers or in cases of minor surgery where 



190 DRUGS. 

the drug can be confined to the part injured. A tight cord should 
be bound around the base of the finger and a 4 to 8 per cent, solution 
injected into the part, the ligature about the base of the digit being 
used to prevent hemorrhage and the systemic absorption of the drug. 
After the operation is concluded slight hemorrhage should be allowed 
to occur, to sweep out the drug and thereby avoid systemic medica- 
tion. Xot more than J grain of cocaine should be injected. When 
operations on a foot or hand have been done under cocaine anaesthesia, 
and larger amounts than this have been used, the constricting bandage 
should be allowed to remain in place some time, since the tissues 
destroy the drug, so that when the bandage is removed less is 
absorbed. (Holscher et al.) 

When a limb must be amputated under cocaine the main supply- 
ing nerve is to be exposed by the aid of infiltration anaesthesia (see 
below), and then the nerve-trunk is to be anaesthetized by the injec- 
tion into its sheath of so weak a solution of cocaine in normal saline 
fluid as 1 per cent. 

Under the name of " infiltration anaesthesia" Schleich has introduced 
a method of destroying sensation in localized areas which often gives 
good results for minor operations. He injects into the skin, as super- 
ficially as possible, a sufficient amount of a solution of common salt, 
cocaine, and morphine to produce local oedema, and thereby pressure on 
the nerve-filaments, which are also depressed by the cold liquid coming 
in contact with them. He also believes that the local anaemia so caused 
aids in destroying sensation. The injection is given so gently that a 
sort of wheal or oedematous spot is produced where the incision is to 
be made. As soon as this spot is developed the needle is inserted 
into its margin and carried under the skin farther, and the injection 
is repeated. In this way the line of an extensive incision can be 
anaesthetized progressively. If deep incisions are necessary, the injec- 
tions are given into the deeper tissues as well. The injections must 
always be made into the healthy skin, as if it is diseased a slough may 
result. Schleich asserts that similar injections under the periosteum 
permit of operations on the bones. The anaesthesia will last twenty-six 
minutes. The solution is of three strengths, as follows : 

Solution. I. II. III. 

Cocaine hydrochloride . . . gr. iv (0.2). gr. ij (0.1). gr. i (0.01). 

Morphine hydrochloride . . gr. h (0.025). gr. | (0.025). gr. ° T \ (0.005). 

Sodium chloride gr. iv (0.2). gr. iv (0.2). gr. iv (0.2). 

Sterilized distilled water. . . fgiv (120.0). f-iv (120.0). • f^iv (120.0). 

To each of these solutions 3 minims of a 5 per cent, solution of car- 
bolic acid arc added. The second solution is the one commonly used. 
The first is employed where acute inflammation is present, and the 
third where repeated injections arc necessary. (Sec Fig. 33.) 

This method of producing anaesthesia has now been tried long enough 
to define its limits of usefulness. For Bmall localized operations it is 
very satisfactory; but for long and deep incisions it is of little value, 
as it- effects are too superficial, and because it in no way diminishes 
the fear and mental Buffering of the patient, in whom the consciousness 
of the operation is worse than the actual pain. There are. however, 



COCA AND COCAINE. 



191 




certain circumstances in which it is to be used in major surgery, 
such as tracheotomy, the removal of small superficial tumors, and in 
those patients who are so profoundly ill 
that it is dangerous to use a general anes- 
thetic, as, for example, in intestinal per- 
foration in typhoid fever, an operation 
which has been done several times with 
this method. As the operation proceeds 
the deeper tissues are anaesthetized by in- 
filtration if possible, and are cut, not torn, 
as the tearing produces great pain. Great 
care that the fluid injected is sterile is 
necessary. 

In some instances in which we are fear- 
ful of the prolonged effects of ether or 
chloroform we can use alternately ethyl 
chloride locally, infiltration anaesthesia, 
and, finally, the general anaesthetic when 
deeper tissues are reached and the radical 
portion of the operation to be performed. 
Morphine may be given before the opera- 
tion in such instances to benumb the ner- 
vous system. 

When skin-grafting is to be done, we 
may resort to the use of cocaine anaesthesia 
of the skin produced by the aid of cata- 
phoresis. (See Cataphoresis.) 

Within the last two years cocaine and eucaine have both been used 
to produce anaesthesia of large areas of the lower portions of the body 
and limbs by injecting them into the subarachnoidean cavity below the 
termination of the spinal cord by means of a long hypodermic needle, 
which is usually introduced between the fourth and fifth lumbar verte- 
brae. By this means the cocaine is brought in contact with the cord and 
its nerve-roots, and anaesthesia in all the tributary parts is produced. 
The operation is best performed with the patient in the sitting 
posture, very slightly bent forward. The skin over the last lumbar 
vertebra is carefully sterilized and then infiltrated with Schleich's 
fluid. A long needle is then inserted at the side of the third or fourth 
lumbar vertebra on a line drawn between the iliac crests across the 
back. (Fig. 34.) It can be felt to pass between the bodies of the verte- 
brae. (Fig. 35.) If there is no escape of subarachnoid fluid, the needle 
is not in the right place. As soon as this fluid appears the syringe, 
already filled with a 2 per cent, cocaine solution, is attached to the 
needle, and from 10 to 15 minims (0.65-1.0) are injected. Anaes- 
thesia is developed in from two to fifteen minutes, and lasts from one 
to five hours. It is needless to point out that not only the skin, but 
needle, the syringe, and the solution should be most carefully sterilized 
before the operation. This method may be resorted to in all cases 
demanding operation below the area injected, and in cases of labor, 
which is thereby rendered painless. Considerable fever, nervous and 



Infiltration anaesthesia. The 
needle is inserted at each suc- 
cessive point as numbered un- 
til the line of anaesthesia is 
complete. 



192 DRUGS. 

circulatory disturbance may arise in susceptible persons ; but Marx 
asserts that if ^-g- grain (0.0003) of hyoscine is given hypodermically 
these symptoms are prevented. In the opinion of the writer, this 
practice will speedily be stopped, as it is unsatisfactory and dangerous. 
A number of deaths have followed its use. In Hahn's statistics there 
were 8 deaths in 1708 operations. It would seem, therefore, more 
dangerous than chloroform. 

Fig. 34. 



Showing the introduction of the needle between the last two lumbar vertebra to produce 
spinal anaesthesia. The syringe is attached to the needle to provide a handle. After the 
physician believes that the needle point is in the subarachnoid space, the syringe is taken 
off the needle in order to see if any cerebrospinal fluid escapes. If it does, this proves 

that the puncture lias been successfully performed. The syringe Idled with the fluid to 
be injected is then attached to the syringe and the injection given. 

Internally, cocaine or the fluid extract of coca may be used as a 
temporary support ant arid stimulant in low fevers, and in cases 
where great physical and mental strain must be borne. Its use for 
any length of time is dangerous and harmful. Thorington has found 
cocaine of very great value in yellow fiver as a stimulant for a short 
time and as an anti-emetic. In the vomiting of pregnancy and other 



COCA AND COCAINE. 



193 



forms of excessive emesis it is of great service by depressing the gastric 
sensory nerves and thereby decreasing the irritability of the stomach. 



Fig. 35. 




A. Space between the third and fourth lumbar vertebrae for subarachnoidean injection 
(Quincke's area). B. Area of puncture suggested by Turner. 



Cocaine is undoubtedly of service in the opium habit, but if largely 
used soon changes the patient from a case of morphiomania to a a coca 
fiend." 

The dose of the fluid extract (Extr actum Cocas Fluidum, U. S., 
and Extr actum Cocce Liquidum, B. P.) is from ^ to 1 drachm (2.0- 
4.0); that of cocaine, from \ to \ grain (0.015-0.03). The other 
B. P. preparations are Lamellce Cocaince, each disk containing -^ 
grain (0.0012) of cocaine hydrochloride, and Unguentum Cocaince and 
Injectio Cocaince Ilypodermica, given in the dose of 1 to 5 minims 
(0.06-0.3). 

The cocaine habit is a condition unfortunately often met with since 
the introduction of the drug into therapeutics. It is often combined 
with the morphine habit, and sometimes is employed as a substitute 
for that morbid state. The symptoms of the cocaine habit consist of 
marked loss of flesh, disorders of the circulatory system, mental fail- 
ure and delusions, sometimes resembling those of chronic alcoholism. 
Often hallucinations come on which are generally of a disagreeable type. 
The habit is difficult to cure, for relapses are frequent. The sudden 
withdrawal of cocaine from a patient may result in profound collapse. 

According to Magnan, a pathognomonic symptom of chronic or 
subacute cocaine-intoxication is a sensation of a crawling worm or bug 
under the skin. 

Untoward Effects. — Sometimes loss of speech, blindless, nausea and 
vomiting, syncope, and unconsciousness have followed the internal use 
or local application of cocaine. Eplileptiform convulsions have also 
been noted, while the circulation and respiration have been disordered 
in every possible manner. In many of these cases the urine passed 
after the poisoning is copious, very limpid, and contains albumin. Curi- 

13 



194 DRUGS. 

ously enough, a large number of cases of severe poisoning have followed 
the injection of cocaine into the urethra previous to some operation for 
the relief of chronic gonorrhoea or stricture. 

The hypodermic injection of cocaine as a stimulant sometimes causes 
vomiting. 

The treatment of the poisoning consists in the use of ammonia, 
coffee, strychnine, or ether and alcohol if the symptoms are those of 
depression. If they are convulsive in type, then the treatment to be 
instituted is identical with that of strychnine-poisoning (which see). 

Out of 250 cases of accidental poisoning arising from the medicinal 
use of the drug, but 13 proved fatal. 

CODEINE. 

Codeina, U. S. and B. P., is an alkaloid derived from opium, and 
is often contaminated by morphine. The sulphate of codeine is gen- 
erally used, as it is more soluble than codeine itself. In the B. P. 
codeine phosphate (Codeines Phosphas) is official. 

Physiological Action. — Codeine resembles morphine very decidedly 
in its physiological action, the chief difference being that it possesses 
less narcotizing power, but in large amount more readily produces 
tetanus and final paralysis of the peripheral motor nerves in the lower 
animals (Dott and Stockman). It does not arrest secretion in the 
respiratory and intestinal tract, as does morphine, and therefore is 
less apt to cause constipation. 

Therapeutics. — Codeine has been highly recommended in France 
as a nervous quietant, and in this country in nervous cough or in 
cases where the cough is excessive in bronchitis and phthisis. In 
diabetes mellitus some clinicians have found it of the greatest value, 
while others have been disappointed in its use. It should, however, 
always be tried in this disease, in the hope that it may exercise a 
favorable effect. When given for cough it should be used in the 
dose of from ^ to 2 grains (0.03-0.12) three or four times a day ; gen- 
erally placed in the syrup of wild-cherry bark. When given for 
diabetes the dose should be much larger, beginning at 1 or 2 grains 
(0.05-0.1), and rapidly increasing it till the glycosuria is diminished. 
Sometimes as much as 20 or 30 grains (1.3-2.0) or more may be 
given daily. The B. P. recognizes a syrup (Syrupus Codeine?) given 
in the dose of 1 to 2 drachms (4.0-8.0). 



COD-LIVER OIL. 

Oleum Morrhuee, U. S. and B. P., sometimes called Oleum Jecoris 
Aselli, is a fixed oil obtained from the fresh livers of the Gadus 
Morrhua, or cod-fish. There are several species of cod from which 
the oil is obtained other than the one named, but this is the chief 
source of supply. The oil is pale or dark according to its degree of 
freedom from foreign materials. Although the paler oils are gen- 
erally prescribed, there can be little doubt that the darker ones are 
more medicinally active. The most prominent inorganic constituents 



COD-LIVER OIL. 195 

of the oil are iodine, bromine, and sulphuric and phosphoric acids. 
It also contains more or less of the biliary salts. 

Lofoten cod-liver oil, obtained from cod caught near the Lofoten 
Islands, is generally considered the best for medicinal use. 

Physiological Action. — Cod-liver oil depends on a number of sub- 
stances for its peculiar effect. The iodine certainly exerts definite 
alterative powers, and the oil seems peculiarly adapted to digestion 
and absorption, for cod-liver oil passes through animal membranes 
very readily, probably owing to the biliary salts contained in it. 

It aids in the maintenance of bodily temperature by its oxidation, 
and causes a deposit of fat in the tissues. The oil also seems to influ- 
ence the blood directly, for clinical observation shows that anaemic 
persons become healthy-looking under its use, and Cutler and Brad- 
ford have found that this apparent improvement is a physiological 
fact by the use of Malassez's blood-cell-Gounting apparatus, the red 
corpuscles being always increased. It has been proved by experiment 
that cod-liver oil is more readily oxidized than any other oil. 

The belief among physicians that the effects of cod-liver oil are 
dependent upon some peculiar combination of substances has shown 
itself in the attempts of physiological chemists to isolate the combina- 
tion. One of the best results reached is the so-called u morrhuol " 
of Chapoteau, who seems to have isolated a crystalline substance con- 
taining phosphorus, iodine, and bromine : 3 to 5 grains of this prepa- 
ration are said to represent 1 drachm of the pure oil, and it is certainly 
of value as a medicament in most of the states in which we use the oil 
itself. In "colds" which "hang on" and are not readily gotten rid 
of morrhuol is best given in capsule or pill. This substance is put on 
the market in gelatin-coated pills or capsules. It does not possess 
the nutritive value of the oil itself. 

Therapeutics. — Cod-liver oil is useful in those persons who have no 
tubercular lesion in the lung or other tissues, but have mucous mem- 
branes which are very susceptible to disease. This state has been 
called the pre-tubercular stage of phthisis. Cod-liver oil possesses no 
curative power in cases of well-developed and rapid phthisis, and its 
administration in many cases serves only to nauseate the patient or 
to produce an oily diarrhoea through failure of digestion. It does good 
in the early stage of the disease in that it acts as a food peculiarly 
suited to a wasting malady, and its mild alterative effects are also of 
value. It maintains the patient's strength and general nutrition, and 
so favorably influences the pulmonary lesion. In chronic rheumatism 
the drug is often of great service, particularly if the disease is largely 
muscular. Strumous shin lesions depending for their existence not 
only upon scrofulosis, but also upon ancemia, often yield to its use. 
In enlargement of the lymphatic glands, where they are not under- 
going acute active suppuration, cod-liver oil given internally does 
good. This is a statement requiring explanation. By acute active 
suppuration is meant the early formation of pus or the molecular death 
of the parts — not the slow formation characterized by no active change, 
but represented by cold abscess or old sores. If the suppurative 
process is chronic, the oil does good by maintaining the patient's 



196 DRUGS. 

nutrition. In cases of strumous ophthalmia cod-liver oil is of great 
service. In advanced syphilis cod-liver oil is most useful, and in the 
early stages of rickets it ought always to be employed. In marasmus, 
when used by inunction or given internally if the stomach will stand 
it, it is one of the best drugs sve have. If a few grains of bile-salts, 
consisting of glycocholate and taurocholate of sodium, be added to 
each drachm of oil, it will be very readily absorbed, from the skin 
when applied by rubbing, or when taken internally. 1 At the present 
time capsules of cod-liver oil, to which has been added some bile-salts 
to aid in the absorption of the oil, can be obtained in the market. 

In sciatica and lumbago and in neuralgia cod-liver oil is of service, 
particularly if those disorders are dependent upon anaemia or an im- 
poverished state of the system. In emphysema of the lungs it is said 
to be of great value, and certain writers commend its use in gout, 
although others have asserted that it is of no value. Sometimes old 
persons, whose digestion is not disordered and who have no organic 
brain disease, complain of giddiness. The best treatment for this con- 
dition, in many cases, is cod-liver oil with small doses of quinine, or 
if these fail wine of ergot and one of the bromides may be used. 

Administration. — Owing to its disagreeable taste and smell most 
patients rebel against taking cod-liver oil ; but this can, with a little 
persistence, be readily overcome, so that finally the patient may not 
object to the remedy, but actually like it. This is particularly 
true of young children. The secret of reaching this much-to-be- 
desired state lies in the use at first of doses which may be dropped 
into a teaspoon and the spoon then gently submerged in a glass of 
milk. The oil floats off into the milk in a globule in the centre of the 
tumbler, and if the milk be rapidly gulped down without the oil touch- 
ing the sides of the glass, it will not be tasted. The first gulps must 
be large enough to include the oil. The oil may be taken on a full 
stomach, but as a general rule it is best digested if taken about two 
or three hours after meals, when the gastric contents are about to be 
passed into the small bowel, where the oil is digested ; and if it be im- 
mediately followed by a little pancreatin, its digestion will be much 
aided. Other modes of ingestion consist in the placing of the oil in 
whiskey or brandy, in the manner which has been described with milk. 
This method possesses the advantage that the alcohol by its stimu- 
lating effect aids very distinctly in the digestion of the oil. Sometimes 
a pinch of salt placed in the mouth before and after the oil is taken aids 
in covering its taste and in its digestion. (See Indigestion.) Oil of 
eucalyptus in the proportion of 1 to 100 of the cod-liver oil will cover the 
hitter's taste, but many persons dislike the eucalyptus more than the cod- 
liver oil. The addition of an equal quantity of glycerin, with ^ to 1 

1 These salts may be bought, or made as follows: To about 300 cc. of ox-gall is 
added nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. 
All the mucus i< now precipitated and the supernatant fluid is filtered. To the filtrate 
i- nddcd a large excess of sulphuric ether, and after a time a plaster-like mass forms 
at the bottom of the vessel, which slowly becomes crystalline. These crystals are now 
placed on a filter-paper and washed with a mixture made up of ether and alcohol, 
equal parts. The filter-paper is dried and the substances then seen are the tauro- 
cnolate and glycocholate of sodium. Having carefully removed these salts from the 
paper, they are ready for use. 



COFFEE— COLCHICUM. 197 

minim (0.3-0.06) of the oil of bitter almonds to each dose, is often of 
service. Syrup of bitter orange-peel is one of the best covers to its 
taste. Tomato ketchup has also been used with good results. Chew- 
ing a piece of smoked herring before and after taking the oil is of value 
to disguise the taste in some cases. The oil is readily taken in soft cap- 
sules holding from J to 1 drachm (1.0-4.0). Very few people are unable 
to swallow such capsules if these are first made slippery by dipping 
them in water. 

Cod-liver oil is most readily digested when given in single nightly 
doses after supper or after a light meal just before going to bed. After 
a few days it may be given after dinner, and in the course of a week 
after breakfast. If the patient is once nauseated by overdoses, it is 
almost impossible to make the stomach retain the oil. If there is diffi- 
culty in digestion, a drachm of ether aids in its absorption, or a drink 
of whiskey or brandy may be used instead. Often a simple bitter, 
such as a dessertspoonful (8.0) of compound tincture of cardamom, taken 
in water immediately after the oil is swallowed, aids in its digestion. 

A large number of preparations of cod-liver oil are on the market 
in emulsion, pancreatized, and purified till they are nearly tasteless. 
Many of the permanent or perfect emulsions contain more Iceland moss 
or acacia than oil. The pancreatized emulsions are the best if the oil 
is present in sufficient quantity to do good, as the very fact of the 
oil being artificially digested adds to its value and makes it possible 
to put more oil into the emulsion. Oil devoid of smell is probably 
devoid of medicinal value, as all the peculiar properties have been 
"purified"' out of it. 

Quite recently it has been suggested that cod-liver oil be given by 
the rectum, a full dose of pancreatin being mixed with it to increase 
its assimilability. Sometimes creosote is placed in this injection in 
5- to 10-minim (0.35-0.65) doses to prevent decomposition-changes 
in the oil and after absorption to act as an expectorant. 

COFFEE. 
(See Caffeine.) 

COLCHICUM. 

Colchicum is the corm {Colchici Cormus, B. P.; Colchici Radix, 
U. S.) and seed {Colchici Semen, U. S. ; Colchici Semina, B. P.) of 
the Colchicum Autumnale, or Meadow Saffron, a plant of Europe, 
containing an alkaloid, colchicine, which may be still further changed 
into colchiceine. While the drug is official in the form of the seeds 
and root, the former are rarely employed. 

Physiological Action. — Colchicum is a very powerful drug, and 
when locally applied is an irritant to the skin. Taken internally in 
overdose, it also severely irritates the gastro-intestinal mucous mem- 
brane. 

According to the studies of one of the writer's students — Dr. 
Ferrer y Leon — the drug has little or no effect when given in mod- 



198 DRUGS. 

erate dose on the nervous system, circulation, respiration, or tem- 
perature, only producing changes in these parts when given in poi- 
sonous doses. In full doses it greatly increases the flow of bile, and 
may cause bilious vomiting and purging. Jacobi asserts that death is 
produced by respiratory failure, the heart continuing to beat for many 
minutes after respiration ceases. The violent gastro-enteritis which is 
present in colchicum poisoning in man certainly has much to do with 
the usual fatal result. 

Therapeutics. — The employment of colchicum in medicine centres 
around its use in gout and similar states, such as chronic rheumatism. 
Indeed, it is almost a specific in acute gout, provided that it be pushed 
until it causes slight griping or laxity of the bowels. Colchicum does 
not seem to possess any marked beneficial effect in preventing attacks. 
Indeed, while it relieves one attack it often seems to hasten the onset 
of the next. In acute gout it is usually well to unload the bowels by 
a small dose of compound extract of colocynth, with some hyoscyamus 
added to it to stop griping. Thus 

K . — Ext. colocynth. comp gr. x vel xx (0.65-1.3). 

Ext. hyoscyami gr. ij (0.12). — M. 

Ft, in pil No. iv. 
S. — One as soon as threatened by an attack. 

This pill is particularly needed if constipation be present and the 
belly is hard. After this has acted the colchicum may be given. Thirty 
to 40 minims (2.0-2.65) of the -wine of the root should be given, and 
20 minims more in twelve hours. In some cases of subacute or chronic 
gout or chronic rheumatism iodide of potassium should be used in 
conjunction with the colchicum. The following may be ordered: 

R.— Potassii iodidi £ss vel ^j (2.0 vel 4.0). 

Vini colchici radicis f ^iss (6.0). 

Villi alb q. s. fgiij (90.0).— M. 

S.— Tablespoonful (15.0) three times a day after meals. Shake well before 
using. 

The use of colchicum in such doses as to cause severe purgation 
or emesis is dangerous, and ought not to be resorted to. Colchicine 
can be used successfully against gout in the dose of y-^ to g 1 ^ of a grain 
(0.0006-0.0012) three times a day. 

Poisoning. — The symptoms of poisoning by colchicum are nausea, 
griping, agony in the belly, purging followed by the passing of thick 
mucus, with great and increasing tenesmus, profuse salivation, col- 
lapse, and death from exhaustion and gastro-enteritis. Bloody purg- 
ing is almost never seen. The poisoning is one of the most painful, 
slow, and hopeless poisonings known, and a man taking as much as 
an ounce of the wine of the root or the seed is almost inevitably 
doomed to a terrible death. Tannic acid may be used as a partial 
chemical antidote, and the stomach washed out by the administration 
of emetics and the use of the stomach-pump. Opium is to be used 
to relieve the pain and irritation, and oils arc to be given to soothe 
the inflamed mucous membrane. If collapse comes on, external heat 



COLLODION. 199 

and stimulants are to be used, and atropine may prove of service 
under these circumstances. 

Administration. — Colchicuin ought never to be used in substance, 
but should be employed in the form of wine of the root ( Vinum Col- 
chici Radicis, U. S.) in the dose of 10 to 20 minims (0.6-1.2), although 
if a marked effect is required 30 minims (2.0) may be used. The 
extract {Extractum Colchici Radicis, U. S.) is given in the dose of 
2 to 3 grains (0.12-0.2), and 'the fluid extract {Extractum Colchici 
Radicis Fluidum, U. S.) in the dose of 2 to 4 minims (0.1-0.3). 

Of the seeds, the tincture (Tinctura Colchici Seminis, U. S. and 
B. P.) is given in 30- to 90-minim (2.0-6.0) doses; the wine ( Vinum 
Colchici Seminis, U. S.) in the same amounts; and the fluid extract 
(Extractum Colchici Seminis Fluidum, U. S.) in the dose of 2 to 5 
minims (0.1-0.3). The B. P. preparations are Vinum Colchici, dose 
10 to 30 minims (0.6-2.0), and Extractum Colchici, dose J to 1 grain 
(0.015-0.05). 

Colchicine is given in pill in the dose of y^- to fa grain (0.0006- 
0.001). 

COLLODION. 

Collodium, U. S. and B. P., is a solution of gun-cotton or pyrox- 
ylon in alcohol and ether, and is a clear, syrup-like fluid, smelling 
strongly of ether. 

Therapeutics. — Collodion is used as an air-tight dressing for small 
wounds and abrasions and for rendering small dressings waterproof. 
A difficulty in its use consists in the contraction which takes place as 
it dries, which draws and puckers the part sufficiently to cause not only 
discomfort, but acute pain. It should be applied with a camel's-hair 
brush. 

In boils, when they are beginning in a small pustule or papule with 
an inflamed zone, collodion painted over the spot, except at its very 
centre, will generally abort the suppuration. If the boil has burst, 
this treatment is useless ; but if it has not, the pus should not be liber- 
ated, but allowed to become inspissated. By this treatment and by 
the frequent application of a coat or two the local trouble eventually 
disappears. Of course, this rule applies only to certain cases, and if 
pain is caused by the retention of the pus, it must be evacuated with 
antiseptic precautions. In smallpox the flexible collodion may be 
used to prevent pitting. 

In gouty inflammations of the joints an application of collodion 
mixed with iodine, equal parts, will often remove the pain, although 
at first the suffering may be increased by this treatment. 

Flexible Collodion. 

Flexible Collodion [Collodium Flexile, U. S. and B. P.) is made 
by adding Canada turpentine 5 parts and castor oil 3 parts to 92 parts 
of ordinary collodion. It does not contract or become hard, and is 
generally to be preferred to ordinary collodion in the dressing of wounds. 



200 DRUGS. 

Styptic Collodion. 

Styptic Collodion {Collodium Stypticum, U. S.) contains tannic 
acid, and is employed to control small hemorrhages. It is seldom 
used, and its employment is a dirty way of controlling bleeding. 

Cantharidal Collodion. 

Cantharidal Collodion {Collodium Cantharidatum, U. S.) has been 
referred to under the head of Cantharides. Collodium Vesicans, 
B. P., is identical with this preparation, and is used for the same 
purpose. 

COLOCYNTH. 

Colocynthis, U. S., is the fruit of the Citrullus Colocynthis, a plant 
at present largely grown in all parts of the world. It contains an 
alkaloid, colocynthine, and a resin. Neither of these is ever used in 
medicine. Colocynth causes large watery evacuations, and may, in 
very large dose, produce fatal gastro-enteritis. It is official in the 
B. P. as Colocynthidis Pulpa. 

Therapeutics. — Colocynth is never used alone, but always in com- 
bination with other drugs of its class as a hydragogue cathartic. 

In cases of chronic dropsy and for the relief of serous effusions 
this drug is generally given in the form of the compound extract of 
colocynth (Extractum Colocynthidis Compositum, U. S. and B. P.), 
which contains 160 grms. of colocynth, 500 grms. of purified aloes, 
140 grms. of the resin of scammony, 60 grms. of cardamom, and 140 
grms. of soap. In the dose of 5 to 20 grains (0.3-1.3) this acts as a 
powerful watery purge useful in dropsy. The extract {Extractum 
Colocynthidis, U. S.) is given with other drugs in the dose of 2 to 5 
grains (0.13-0.3) as a purge. The following is a useful form in which 
to administer it : 

&• — Extract, colocynth gr. xxx (2.0). 

Extract, belladonna; gr. ij (0.1). 

Extract, nucis vomicae gr. ij (0.1). — M. 

Ft. in pil. Xo. x. 
S. — One each morning. 

Colocynth is one of the principal ingredients in compound cathartic 
pills (PiluloB Cathartics Composites, U. S.) Each pill contains : com- 
pound extract of colocynth, IJ grains (0.09); extract of jalap and 
calomel, of each 1 grain (0.06) ; gamboge, ] grain (0.015). This pill 
is not to be used constantly, as it eventually makes the bowels more 
constipated than before. The U. S. P. of 1890 also orders a pill 
(Piluhi- CaiharticcB VegetaMles, U. S.) which contains compound 
extract of colocynth, extract of hyoscyamus, extract of jalap, extract 
of leptandra, resin of podophyllin, and oil of peppermint. This is 
given in the dose of 1 to 2 pills. 

The preparations of the B. P. not official in the U. S. P. are: 
PUula Colocynthidis Composita, composed of colocynth-pulp, aloes, 



COND URANGO— CONIUM. 201 

scammony, sulphate of potassium, and oil of cloves, dose 5 to 10 
grains (0.3-0.65); Pilula Colocynthidis et Hyoscyami, dose 5 to 10 
grains (0.3-0.65). 

CONDURANGO. 

Condurango is the bark of Condurango Blanco, a tree of Colombia, 
South America. Martindale and Westcott state it is the Gonolobus 
Condurango. It was introduced into medicine in 1873 as a cure of 
gastric cancer, and at one time had a favorable reputation. We now 
know that, so far as the morbid growth is concerned, its action is 
valueless, but there is no doubt that it diminishes the severity of the 
symptoms in many cases by exercising a favorable effect on the gastric 
mucous membrane. It also tends to relieve the accompanying gastric 
catarrh through its action as a stomachic. 

The bark is never employed as the bark, but in the form of the 
fluid extract, dose 1 to 2 drachms (4.0-8.0), or the wine, dose J to 1 
ounce (15.0-30.0). Sometimes it is given in the form of a decoction 
made by adding 1 part of the bark to 8 parts of water, which is given 
in the dose of 1 tablespoonful (2.0) three times a day. Often it is wise 
to add to the prescription a little hydrochloric acid to take the place of 
the natural acid of the stomach, which is usually lacking in such cases. 

CONIUM. 

Conium (Z7. S.) is the leaves and fruit of the Conium maculatum. 
The plant grows in Europe and the United States, and contains a 
liquid alkaloid known as conine. This drug is official in the B. P. 
as hemlock-leaves {Oonii Folia) and hemlock-fruit (Conii Fructus). 

Physiological Action. — Conium in full medicinal dose produces a 
feeling of relaxation and loss of muscular power, and if the dose be 
very large it causes giddiness, staggering, and disordered vision, with 
failure of the circulation. 

Nervous System. — Conium depresses the motor nerves, and, if 
the dose be extraordinarily large, the sensory nerves. Upon the 
spinal cord it exerts a feeble depressing influence, but has no posi- 
tive effect, while the fact that consciousness continues almost up to 
death shows that the intellectual portion of the cerebrum escapes its 
influence. 

Circulation.- — The action of the drug upon the circulation is 
depressant. It causes at first a fall of arterial pressure, then, if the 
dose be large, a rise, due to the asphyxia caused by nervo-muscular 
failure of the respiratory apparatus. Finally, a constant fall of press- 
ure takes place. 

RespiRx\.tiox is depressed, because of the paralytic influence of 
the drug on the nerve-trunks supplying the respiratory muscles. 

Therapeutics. — Conium holds an unimportant place in the drug-list 
of to-day. It has little value except in spasms due to irritation of a 
nerve-trunk, when it may be of service. In spasms of cortical or 
spinal origin other drugs should be used, as it is evident that conium 
has really no effect in quieting the central nervous protoplasm, but 



292 



DRUGS. 



Fig. 36. 




Dnly prevents the impulses which are sent out from manifesting them- 
selves in movements of the muscles. The powdered leaves or other 

preparations may be smeared over poul- 
tices to relieve the pain of ulcers and 
cancers, and they certainly do good in 
such instances. 

Administration. — The dose of the al- 
coholic extract (Extr actum Conii, U. S.) 
is from I- to 1 grain (0.03-0.06), and 
of the fluid extract (Extr actum Conii 
Fluidum, U. S.) 2 to 6 minims (0.1- 
03). The dose of the tincture (Tinc- 
tura Conii, B. P.) is 10 to 30 minims 
(0.65-2.0). Conine is a liquid' alkaloid 
which should never be used. The dose 
of the hydrobromide of conine is said by 
Helbing to be \ to ^ a grain (0.01- 
0.03). The preparation in the B. P. 
made from the leaves is Succus Qonii, 
dose 1 to 2 fluidrachms (4.0-8.0). 
Vapor Conii consists of the juice of 
hemlock (Succus Conii) \ ounce (15.0), 
liquor potassa 1 drachm (4.0), and dis- 
tilled water 1 ounce (30.0). 20 minims 
(1.2) of this mixture are placed in hot 
4, contumacy in an inhaler, and so employed 

for the relief of irritative coughs or 
spasmodic asthma. Unguentum Conii is official in the B. P., and is 
used in pruritus ani. 

It is to be remembered that the variability of the drug, so far as 
power is concerned, is very great — so great as to make it unreliable. 
For this reason a small dose should be given at first and the amount 
gradually increased. 

Poisoning. — A prominent symptom of poisoning by conium is drop- 
ping of the eyelids (ptosis), due to paralysis of the oculo-motor nerves, 
and staggering and inability to walk. Its treatment consists in the 
use of strychnine as a respiratory and nervous stimulant, the employ- 
ment of external heat, and the use of cardiac stimulants if the circu- 
lation fails. The stomach is to be emptied by emetics or the stomach- 
pump before the antidotes are used. 




CONVALLARIA. 



This drug is derived from the rhizome and root-stalk of Conval- 
laria majalis. It is employed in medicine as a cardiac tonic to fulfil 
the iii<li<-;itioiis which direct us in the use of digitalis. While by no 
means so valuable a drug as foxglove, it sometimes acts better in an 
individual case than the older remedy. The heart is not greatly 



COPAIBA. 203 

slowed by it, but the drug is particularly useful in cases of arhythmia 
and "cardiac hurry." 

The dose of the fluid extract (Extractum Convallarice Fluidum, 
U. S.) is from 4 to 8 minims (0.2-0.5) three times a day. The tinc- 
ture (Tinctura Convallarice) is given in the dose of 5 to 20 minims 
(0.3-1.3). Convallamarin is a glucoside of convallaria which has 
been used in the dose of -J- a grain (0.03) three times a day. Some 
clinicians think it ought to be given but once a day on account of 
a danger of cumulative action. 



COPAIBA. 

The Copaiba of the U. S. P. and B. P. is really the balsam or 
the oleoresin of Copaifera Langsdorffi, and is a clear, transparent 
liquid of oily consistency, of a pale-yellow color and a peculiar odor. 
From it is distilled an oil (Oleum Copaibas, U. S. and B. P.) which is 
of little value. 

As copaiba is an oleoresin, the term "oleoresin of copaiba" is 
often used to distinguish it from the oil. 

Therapeutics. — Copaiba is used for the purpose of stimulating the 
mucous membranes of the genito-urinary tract, particularly when they 
are depressed after a period of inflammation, as in the later stages of 
gonorrhoea. In cases suffering from chronic urethritis with anaemia 
and debility the following prescription is useful. (See also Methylene- 
blue.) 

R. — Oleoresime copaiba? ^j (4.0). 

Oleoresinse cubebse gtt. iv (0.26). 

Ferri et ammonii citratis gr. xx (1.3). — M. 

Pone in capsulas No. x. 
S. — One t. i. d. after meals. 

Copaiba is employed in subacute and chronic bronchitis as a stimu- 
lant expectorant. In the treatment of subacute pyelitis, cystitis, and 
dysentery it is of value. In dropsy due to slow renal changes it will 
often be of service as a renal stimulant and diuretic. 

Administration. — Copaiba itself is given in the dose of 5 to 20 
minims (0.3-1.3) in capsule or in emulsion. The oil of copaiba 
(Oleum Copaibas, U. S. and B. P.) is given in capsule or emulsion, 
preferably in the former, in the dose of 10 to 20 minims (0.65-1.3) 
two to four times a day. Sometimes it is dropped on sugar and so 
administered. Massa Copaibas, U. S., is made by rubbing up copaiba 
with magnesia, but this is a useless and clumsy way of using it in the 
pill form. 

The drug is eliminated in the urine, and gives the test for albumin 
with nitric acid. 

In some cases it causes urticaria, which soon disappears on the with- 
drawal of the drug. 



204 DRUGS. 



COPPER. 



Cuprum is never used in the form of the metal itself, but chiefly 
as the sulphate, which appears in commerce as a blue, clear, some- 
what efflorescent salt. It is soluble in 4 parts of cold water, 2 of 
boiling water, but is not soluble in alcohol. 

Physiological Action. — Copper sulphate, when locally applied to a 
mucous membrane, acts as a powerful astringent, or on the surface 
of an ulcer as a mild and superficial caustic. When given in over- 
dose by the stomach it causes death by violent gastro-enteritis and 
exhaustion. The symptoms do not generally come on for an hour, 
and consist in burning pain in the stomach, a copperish or metallic 
taste in the mouth, followed by vomiting of bluish liquids and glairy 
mucus. With the vomiting, purging comes on, the passages at first 
containing the contents of the intestine, and finally mucus and blood. 
Convulsions of an epileptiform character are present, and constant 
and profuse salivation is not infrequent. After death fatty degene- 
ration of the liver and kidneys has been noticed, and it is not at all 
uncommon for jaundice to appear after the first twenty-four hours, 
if the patient survives so long. This jaundice is dependent upon 
changes in the blood. The treatment of the poisoning consists in 
the primary use of the chemical antidote, which is the yellow prus- 
siate of jiotassium, and the administration of emollient or demulcent 
substances, such as sweet oil and white of eggs, followed instantly by 
emetics or the stomach-pump. If emesis and purgation are already 
active, emetics are of course contraindicated, and counter-irritation 
is to be employed over the stomach and intestines in the shape of a 
mustard plaster of moderate strength, and opium given to allay irrita- 
tion and relieve pain. 

Chronic copper poisoning is almost never seen, and, although the 
metal is widely used for coloring canned green vegetables, it seems 
to be harmless when ingested in such small amounts. 

Therapeutics. — Sulphate of copper (Cupri Sulphas, U. S. and 
B. P.), in the dose of 5 to 7 grains (0.3-0.4) may be used as a rap- 
idly-acting emetic which only acts upon the stomach, not the vomit- 
ing centre. As it is irritant, the emetic dose ought not to be repeated, 
but if emesis does not occur the sulphate of zinc or mustard should 
be used to empty the stomach. Indeed, it may be said of sulphate of 
copper that it should never be given as an emetic if any other emetic 
can be found. Thornton has proved in the Laboratory of Experi- 
mental Therapeutics of the Jefferson Medical College that an antidotal 
dose of copper sulphate given to a dog poisoned with phosphorus may 
produce death before the phosphorus can cause a lethal result. The 
drug is therefore a theoretical but not a practical antidote to phos- 
phorus. In pill form it is sometimes given in diarrhoeas depending 
upon ulceration of the bowels. The dose should be \ to 1 grain 
(0.015—0.06) combined with opium. 

In some states of the body, particularly in skin diseases of the dry 
type and in persons with tubercular tendencies, copper seems to act 
like arsenic, and maybe used in minute doses of -^ of a grain (0.006) 



COTARNINE— CREOSOTE. 205 

or less three times a day where arsenic is not well borne. In small 
doses it is said to be a direct stimulant to the tissues, and to increase 
the firmness of the flesh and strength of the normal man. Very 
recently strong claims for copper as a remedy for ancemia have been 
put forward, particularly if it is employed as the arsenite of copper, 
when the action of the arsenic and copper together produces a good 
effect. 

Locally applied, sulphate of copper is useful, in the solid form or 
in powder, in the treatment of indolent ulcers. In chronic conjunc- 
tivitis or in cases of tinea tarsi — that is, tinea on the margin of the 
eyelids — a crystal of the sulphate may be drawn over the diseased 
spot ; or a weak solution of 1 to 3 grains (0.06-0.18) to the ounce (30.0) 
of water may be dropped into the eye in subacute conjunctivitis. 

In relaxed sore throat, as a gargle, in the strength of 4 grains 
(0.26) to the ounce (30.0), it is often of service. 

COTARNINE. 

Cotarnine is prepared from narcotine, one of the alkaloids of opium, 
but its physiological effect is closely allied to that of hydrastinine, 
derived from hydrastis. In the form of cotarnine hydrochlorate it 
has been placed on the market as " Stypticin," and this is used as a 
remedy for oozing hemorrhages, such as menorrhagia and metrorrhagia, 
and as a local application in epistaxis. It may be given in the dose 
of from J to 4 grains (0.03-0.26) three times a day in pill, tablet, or 
elixir, or in capsule, or by the hypodermic syringe in the dose of 1 to 
2 grains (0.06-0.12). 



CREOSOTE. 

Creosote (Oreosotum, U. S. and B. P), as employed in medicine, 
should always be derived from the destructive distillation of beech- 
wood and be designated " beechwood creosote." Much of that sold 
is derived from coal-tar, and is far less useful. Chemically, creosote 
is almost identical with carbolic acid. Clinically, it is very different. 
Beechwood creosote should be of a reddish-amber hue and about as 
thick as olive oil. Its physiological action is almost identical with 
that of carbolic acid, and in poisoning by creosote the same antidotes 
as are employed in carbolic-acid poisoning — namely, soluble sulphates 
— should be used, as has been proved in experiments by the author. 
Creosote contains 60 per cent, of guaiacol and 40 of cresol, not creosol. 
Guaiacol is sometimes used in place of creosote in the dose of 1 to 2 
minims (0.06-0.13). (See Guaiacol.) Creosote is a powerful anti- 
septic. 

According to the studies of Imbert, creosote is eliminated chiefly 
by the kidneys in the form of guaiacol sulphate and creosol sulphate 
of potassium. Elimination does not go on very rapidly, for this 
investigator did not find it completed for about twenty-eight hours. 
A small amount of the drug is eliminated by the lungs. 



206 



DRUGS. 




Therapeutics. — During the past few years creosote has been largely 
prescribed in pulmonary tuberculosis and chronic bronchitis, and some 
of the results reached by its use have undoubtedly been of value. (See 

article on Tuberculosis.) It has 
Fig. 37. also been inhaled from sponges with 

great relief, and even has been in- 
jected into the lungs by way of the 
trachea or through the chest-wall. 
In the treatment of chronic bron- 
chitis creosote may be placed in 
j boiling water and inhaled in the 

jijiV steam. Under these circumstances 

it relieves the fetor of the breath, 
and this method often gives more 
!jn I rapid relief than any other measure 
J&l in the treatment of ordinary sub- 
acute inflammation of the bronchi. 
(See Inhalations.) The beginning 
dose when the drug is given inter- 
nally is 2 to o minims (0.1-0.35). 

It is useless to attempt to cure 
pulmonary tuberculosis by the ad- 
ministration of creosote, and its 
Yeo's inhaler made of perforated zinc bound chief value in the disease depends 

on the edges with chamois, and supplied 1rnnT , ifc nptirm n« nn PYnprtnrant 
with elastic loops to go back of the ears. u P on 1TS actlon as an expeCIOiant 

on a sponge placed in the front of the in- affecting favorably the profuse bron- 

haler is dropped the medicine to be in- . . , D . «- . L , „ 

haled. dual secretion associated so often 

with the involvement of the lung- 
tissues by the tubercular process. Creosote does good, indirectly, by 
relieving this complication ; but it is apt to disorder the digestion. It 
ought not to be employed in every case, since its value in relieving the 
bronchial disorder is far outweighed by the disturbance of digestion in 
many instances. If fever or hemoptysis is present, the use of creosote 
is contraindicated. When it is desired to relieve profuse muco-puru- 
lent expectoration creosote may be given in capsules or as follows : 

R— Creosoti (beech wood) f^iij (12.0). 

Tinct. gentian, comp , fjj (30.0). 

Spt. vini rectificati f 3viij (224.0). 

Vini Xerici Oij (1 litre).— M. 

S. — A tablespoonful in a wineglassful (16.0: 64.0) of water three times a day. 

In other cases the creosote may be dropped into half a glass of milk 
and taken in this three times a day. Often as much as a drachm a 
day can be given by gradually producing tolerance through ascending 
doses; and it is worthy of note that in most instances large doses are 
required if satisfactory results are to be obtained. (See article on 
Tuberculosis, Part IV.) 

Inhalations of the drug often give relief in the advanced stages of 
phthisis, and decrease the cough, allay the laryngeal dryness, and aid 
expectoration. When creosote is given hypodermically in phthisis, it 
may be given in the following formula: 



CREOSOTE CARBONATE. 207 

R.— Creosoti f^ij (8.0). 

Olei amygdal. dulcis f^ij (8.0).— M. 

S. — 10 minims (0.65) to be injected deeply into tissues below the scapula. 

This method is not to be employed except in rare cases. Indeed I 
have yet to see a case in which its use seemed wise. 

In the treatment of subacute laryngitis a fine spray of 1 to 2 min- 
ims (0.05-0.1) of creosote, 4 grains (0.2) of menthol, and 1 ounce (32.0) 
of albolene is of service used several times a day ; or a mixture com- 
posed of creosote 10 minims (0.65), chloroform spirit 10 minims (0.65), 
and alcohol 20 minims (1.3) may be placed on the sponge of an inhaler 
and inhaled. It is also claimed that wetting cloths with creosote and 
hanging them in the air of a nursery will often be of great value in 
whooping cough. (For methods, see Inhalations, Part III.) 

Sometimes creosote is given by enema in pancreatized cod-liver oil 
to children with pulmonary or peritoneal tuberculosis, in the dose of 
from 5 to 15 minims (0.3-1.0). 

Creosote is a valuable remedy in cases of indigestion with fer- 
mentative changes is the gastric contents when these arise from the 
deficient digestion of meats or the use of sweets, when given in the dose 
of ^ to 2 minims (0.03-0.1) after meals, preferably in tablet or capsule. 
Applied on a pledget of cotton to the cavity of a tooth, creosote often 
relieves toothache by virtue of its anaesthetic influence over peripheral 
sensory nerves. 

While ordinary medicinal doses of creosote rarely cause disagree- 
able symptoms, except some disorder of the stomach or bowels when 
it is pushed in full doses, the physician who is ordering large amounts 
should be always on the lookout for toxic symptoms. These consist in 
vertigo, headache, and a tendency to stupor, and the urine may become 
smoky in appearance, as in carbolic-acid poisoning. If any of these 
signs of overdosing appear, the drug must be reduced in dose or 
stopped altogether. 

The preparations of creosote are Aqua Creosoti, U. S., which is 
given in the dose of 1 to 3 fluidrachms (4.0-12.0) ; Mistura Creosoti, 
B. P., dose 1 to 2 fluidounces (32.0-64.0); Unguentum Creosoti, B. P., 
for local application. 

CREOSOTE CARBONATE. 

Creosote carbonate, sometimes called " Creosotal," is a combination 
of creosote with carbonic acid. Over 90 per cent, of creosote car- 
bonate is said to be creosote. It is a thick, oily fluid of an amber 
color, with but little taste or odor, and is insoluble in water, dilute 
alcohol, and glycerin, but is soluble in 95 per cent, alcohol, in ether, 
chloroform, and in cod-liver and olive oils. It is said to be less irri- 
tating to the stomach than creosote. The drug is dissolved and ab- 
sorbed chiefly in the intestine. The dose of creosote carbonate is 
identical with that of creosote itself, and it is used as an expec- 
torant in pulmonary tuberculosis and as an intestinal antiseptic. 
It is best given in olive oil in capsules. (See also Guaiacol, Car- 
bonate of.) 



208 DRUGS. 



CREOLIN. 



Creolin is a liquid cresol, a coal-tar product, possessing marked 
antiseptic but comparatively slight poisonous properties. In appear- 
ance it is a dark-brown fluid, and is derived from soft coal. It is of 
the consistency of syrup. "When added to water it forms a white 
cloud and mixes thoroughly, forming an emulsion up to 12 per cent, 
of the drug. 

Therapeutics. — Creolin is used as an antiseptic in the lying-in 
state, as a wash for the hands, and for vaginal irrigation. It cannot 
be used as a solution in which to place instruments, as it makes so 
opaque a mixture with water as to prevent their being seen when lying 
at the bottom of the dish. When used as a vaginal douche it should 
be employed in the strength of 2 per cent. One of its properties which 
is of value is that it forms a slippery coating over the maternal parts 
during parturition. In the treatment of cystitis in the female, Parvin 
highly recommended it as a vesical wash in the strength of a 1 per cent. 
solution, or. after the bladder becomes accustomed to its use, in a 2 per 
cent, solution. According to Kretzschmar and others, a solution of 
1 to 500, used with a syringe, is useful in otorrhoea, 1 to 100 in nasal 
ulcers, and 1 to 1000 as a nasal douche in rhinitis when there is 
much discharge with the formation of crusts. Creolin has also been 
used as an injection in the proportion of 5 parts in 1000 of water for 
dysentery and colitis with success. 

In the eye Alt has used with good results a 1 to 2 per cent, solution 
in the treatment of blepharitis, keratitis, and phlyctenular ophthalmia. 

CROTON CHLORAL. 

Croton Chloral, or Butyl Chloral Hydras. B. P., has a physio- 
logical action closely allied to chloral itself, but it possesses more anal- 
gesic power and is very much less depressant to the heart and circu- 
lation. The dose for the production of sleep is the same as chloral, 
5 to 20 grains (0.3-1.3) in syrup. 

Therapeutics. — Croton chloral is preferable to chloral in sleepless- 
due to pain. 

In facial neuralgia and migraine it is exceedingly efficacious, par- 
ticularly if the fifth nerve be involved. In headaches due to eye- 
strain, and in those associated with sick stomach, but not due to 
gastric indigestion or nervous debility, croton chloral is of service. 
Curiously enough, it is valueless in toothache, but does good in the 
neuralgia due to decayed teeth. 

Administration. — Croton chloral should be used in pill form in the 
dose of 3 to 5 grains (0.2-0.3) every two hours till the pain is 
relieved or sice]) comes on, or it may be given in solution or syrup 
of acacia and water, or water and glycerin. It has been used in as 
large a dose as (JO grains (4.0), but 20 to 30 grains (0.65-2.0) ought 
to be the maximum dose as a general rule. 



CROTON OIL—CUBEBS. 209 



CROTON OIL. 



Croton oil (Oleum Tiglii, U. S. ; Oleum. Crotonis, B. P.) is an 
exceedingly irritant oil derived from Croton Tiglium, a small tree of 
India. The oil is pale yellow and of a complex character. Applied 
to the skin for any length of time, it is an intense irritant, producing 
blisters or pustules. 1 minim (0.06), placed on the tongue with 5 
minims (0.35) of sweet oil, acts as a violent watery purge, and, owing 
to the smallness of its dose, it is frequently employed to revulse the 
unconscious, as in cerebral congestion. In delirium it is used for the 
same purpose, and may be given to maniacs who are suffering from an 
attack of cerebral congestion or obstinate constipation, owing to the 
smallness of its dose and rapidity of action. The dose is 1 minim (0.06) 
placed on the tongue with sweet oil or given in emulsion or in pill. 
It ought never to be used when there is any irritation of the stomach 
or bowels. As a counter-irritant it is sometimes applied over a ten- 
der nerve or to the chest in the treatment of bronchitis, in the pro- 
portion of half-and-half with sweet oil. Thus applied, it may be 
absorbed and cause purging. The treatment of poisoning by croton 
oil is identical with that of gastro-enteritis. (See Gastro-enteritis.) 
Linimentum Crotonis is a preparation of the B. P. which is employed 
as a counter-irritant liniment for sprains and in muscular rheumatism. 



CUBEBS. 

Cubebs (Cubeba, U. S.) and Fructus, B. P.) are the unripe fruit 
of Piper Cubeba, a plant of Java. They consist in wrinkled or rough 
black bodies about the size of small peas, and have an aromatic, 
pungent taste. They contain a volatile oil, cubebic acid, and cubebin. 
The drug should not be kept in powdered form, as it loses its powers, 
but should be powdered as needed. Overdoses of cubebs cause gastro- 
intestinal and genito-urinary inflammation. 

Therapeutics. — Cubebs are used in the advanced stages of gonor- 
rhoea where a tendency to a chronic discharge is present. Some sur- 
geons have used them in the early stages as an abortive treatment, 
but this is a bad practice. In cold in the head the powdered berries 
may be snuffed up the nostril, provided that the stage of secretion is 
well established. They ought not to be used before this stage. In 
the treatment of chronic or subacute bronchitis the oleoresin of 
cubebs is very useful in some cases (see Bronchitis), and in the form 
of cubeb cigarettes the drug is much used as a remedy for hoarseness 
due to subacute laryngitis. 

Administration. — Cubebs may be given in powder in the dose of 
10 to 60 grains (0.65-4.0), in the fluid extract (Extractum Cubeba? 
Fluidum, U. S.) 10 to 30 minims (0.65-2.0), and in the form of the 
tincture (Tinctura Cubeba?, U. S. and B. P.) in the dose of 10 minims 
to lan ounce (0.65: 16.0). 

The dose of the oleoresin (Oleoresina Cubebce, U. S.) is 2 to 20 
minims (0.1-1.3) three times a day, and it may be given in capsules or 

14 



210 DRUGS. 

emulsion. The troches of cubebs (Trochisci Cubebce, U. S.) are 
used for the relief of pharyngitis of a chronic type. The dose of the 
oil (Oleum Cubebce, U. S. and B. P.) is 5 to 20 minims (0.3-1.3). 



CUSSO. 

Ousso, U. S. and B. P., sometimes called Kousso. is derived from 
Brayera Anthelmintic^ a plant of Abyssinia. In the U. S. P. of 
1880 it was called Brayera. It contains a volatile oil, tannic acid, 
and koosin or taeniin. The drug is used against the tape-worm, and 
is most valuable as a vermifuge, also possessing the advantage of 
safety. It should be used in an infusion (Infusum Brayerce) in the 
dose of \ an ounce (16.0) of the powdered flowers to a pint (500 
cc.) of water, and be taken in the morning on an empty stomach. 
(See Worms.) Koosin may be used in the dose of 20 to 40 grains 
(1.3-2.5) in capsule. The fluid extract (Extr actum Cusso Fluidum) is 
given in the dose of J an ounce (16.0). It has been said that the 
drug is apt to cause abortion in pregnant women, but this is not 
known to be a fact. 



CYANIDE OP POTASSIUM. 

Cyanide of Potassium (Potassii Qyanidum, U. S.) is used in the 

same way and for the same purpose as hydrocyanic acid. (See 
Hydrocyanic Acid.) The dose is ■£% to ^ of a grain (0.006). 

The following prescriptions may be used in cases suffering from 
bronchitis or phthisis accompanied with excessive cough : 

R. — Potassii cyanid gr. ij (0.1). 

Morphinse sulpfa gr. j (0.05). 

Syr. prnni virginianse q. s. ad f^iij (90.0). — M. 

S. — Teaspoonful (4.0) three to five times a day. 

Or as follows : 

R. — Potassii cyanid gr. ij (0.1). 

Amnion, chloridi ~ij (8.0). 

Elix. ealisayse . . q. s. ad f-'iij (90.0).— M. 

S. — Teaspoonful (4.6; three or four times a day. 



DERMATOL. 
(See Bismuth Subgallate.) 

DIASTASE. 

The word diastase is applied to substances found in certain of the 
digestive juices of the animal body and present in processes connected 
with the fermentation of grain, as, for example, in the manufacture of 
alcoholic bev< _ - \\ hatever diastase may be in one sense, we recog- 



DIGITALIS. 211 

nize that it belongs to the same class of enzymes as pepsin and pancrea- 
tin, and that it has the power of converting starch into sugar. Many 
preparations of malt contain some diastatic power, but there is only 
one preparation of diastase, which possesses no other property save that 
of aiding the digestion of the starches — namely, one prepared origin- 
ally by a Japanese investigator, Takamine, and called from his name 
" Taka-diastase." It is used to relieve cases of indigestion of the 
starchy foods in the dose of 2 to 5 grains after meals, in tablets or 
capsules or in a solution, and is a most efficient remedy. 
A very useful formula is as follows : 

R— Taka diastase gr. xlv (3.0). 

Cnpri arsenit gr. ^ (0.01). 

Extract, nucis vomicae gr. iv (0.2). — M. 

Form in capsules No. xx. 
S. — One capsule with meals. 

Often a little capsicum may be added to this prescription, in the 
treatment of atonic dyspepsia, with advantage. 

DIGITALIS. 

Digitalis, JJ. S., is the leaves of Digitalis purpurea, or Foxglove, of 
the second year's growth. The leaves are official in the B. P. as Digi- 
talis Folia. It contains a number of substances, no single one of 
which acts as do preparations of the crude drug. In other words, 
all these compounds must act together to produce therapeutic effects 
similar to those obtained when digitalis leaves are given. Among 
the substances so far isolated from digitalis by chemists may be 
named digitalin, digitalein, digitoxin, digitin, and digitonin. Several 
of these are probably compounds of the others. Digitalin, so called, 
occurs in two forms, amorphous and crystalline. The crystalline digi- 
talin (French) is largely digitoxin, while the amorphous is composed 
of digitonin, digitalein, and digitalin. A pure digitalin has, however, 
been isolated, which can now be obtained from Merck. Digitoxin and 
pure digitalin are the two most active principles yet found. None of 
these substances should be used in medicine to completely take the 
place of digitalis, but digitalin may be used as a heart stimulant. 

We have already pointed out in the early part of this volume the 
necessity of employing reliable drugs. In the instance of digitalis 
this is particularly important, because the cases in which it is used 
are often serious, and because digitalis varies greatly in strength. 
As a rule, the wild digitalis is stronger than the cultivated, and the 
English or German digitalis is better than the American. The prep- 
arations of digitalis should therefore be obtained from a first-rate 
manufacturing pharmacist after they have been physiologically tested. 

Physiological Action. — Digitalis is apt to irritate mucous membranes 
which are already slightly out of order, and for this reason should not 
be given by the mouth in cases of gastritis and allied states if it can be 
avoided. 

Nervous System. — The action of digitalis upon the nervous sys- 
tem is only manifested when poisonous doses are used. Small toxic 



212 



DRUGS. 



doses decrease reflex activity by stimulating Setschenow's reflex inhib- 
itory centres in the medulla, and finally by depressing the spinal cord. 
Convulsions are sometimes seen as a result of the action of decomposi- 
tion products of digitalis — namely, toxiresin and digitalresin. Finally, 
the motor nerve-trunks themselves are depressed and the muscles are 
paralyzed. 

Circulation. — Upon the circulatory system digitalis exerts its chief 
influence. In moderate or medicinal amounts it increases the pulse- 
force and arterial pressure, slows the pulse, and increases the size of the 
pulse-wave. The increase of pulse-force is due to a stimulating influ- 
ence exercised upon the cardiac ganglia and the muscular fibres of the 

Fig. 38. 




A, Digitalis stimulates the heart; B, stimulates the vagus centres ; C, stimulates the peripheral 
ends of the vagi ; J), stimulates the vasomotor centre ; E, stimulates the walls of the blood- 



heart ; the rise of arterial pressure is caused by the increase in pulse- 
force and pulse-volume, and by a stimulation of the vasomotor centre 
and the muscular coats of the blood-vessels, whereby a contraction occurs 
in the walls of the arteries and arterioles. The slow pulse is produced 
by stimulation of the pneumogastric centre and the peripheral ends of 
the vagus nerves. T 
this influence on the 

lated, the diastole of the heart is more full and complete and occupies a 
greater length of time. The result of this delay is that the ventricles 



lie increase in the volume of the pulse is due to 
vagi, for, the pneumogastric nerves being stimu- 



DIGITALIS. 



213 



become thoroughly distended, and on contracting drive out a much larger 
wave of blood through the aorta than is normally sent out (Figs. 38 
and 39). This is important to remember when using the drug in heart 
disease and other states. While we do not know that the vagi are the 
trophic nerves of the heart, we have a large amount of evidence 
in favor of such a view, and it has long been thought that digitalis 
was not only a heart stimulant, but a remedy that increased the 
growth of its muscular tissue. If the trophic nerves of the heart are 
stimulated by digitalis, it becomes evident that it is a doubly useful 
remedy. 1 (See the article on " Heart Disease " in Part IV. of this 



Fig. 39. 



WWy^/WWy 



II 




III 




IV 



Showing the effect of digitalis on the circulation. (After Schmiedeberg.) I. Before digitalis 
was used : blood-pressure 86, pulse 21 in 10 seconds. II. After the use of digitalis : 
blood-pressiire 150, pulse 22 in 10 seconds. III. After another dose : blood-pressure 164, 
pulse 20. IV. After another dose ; blood-pressure 210, pulse 40. 



volume for a further explanation of the influence of digitalis in 
improving the nutrition of the heart muscle.) 

When full medicinal doses of digitalis are repeatedly given, or when 
poisonous doses are ingested, the action of the heart becomes exceed- 
ingly irregular, hobbling, and dicrotic. (See Poisoning.) What the 
cause of this irregularity is we do not know. It is certainly not due to 
weakness, for the cardiac beats, when they occur, are in themselves 
more forcible than in health. The probable explanation of this peculiar 
cardiac irregularity lies in a disturbance of the co-ordinating apparatus 
of the various parts of the heart muscle. By this the author does not 
refer to the so-called co-ordinating centre of Kronecker and Schmey, 

1 In an original study by the author he found that when digitalis is given con- 
tinuously for a long period of time there results cardiac hypertrophy independently of 
any valvular lesion. See Therapeutic Gazette, December, 1897. 



214 DRUGS. 

which probably does not exist, but to the changes which may take 
place in the so-called "contraction wave," which is found to begin in 
the normal heart at the great veins and passes from them through the 
auricular walls to the walls of the ventricles. It has been found by 
Wooldridge and by Tigerstedt that if the auricle and ventricles be 
separated by a ligature or clamp, they still continue beating, but no 
longer do so synchronously, or, in other words, the centres of each set 
of walls act independently of the others. The irregular action of the 
heart under digitalis is probably dependent upon a disassociation of 
these centres ; and this theory is still further substantiated by the 
experiments of Roy and Adami, who have proved that independent 
contraction of the various parts of the heart can be produced by stim- 
ulation of the peripheral end of the cut vagus, a part of the nerve 
which is stimulated by digitalis in the large doses which we have been 
considering. In man we sometimes see this irregular pulse replaced 
by an exceedingly rapid pulse, which is shuttle-like in character ; and 
whether the pulse be irregular or rapid, the arterial pressure is always 
low, owing, first, to the imperfect action of the heart, and, second, to 
a depression of the vasomotor centres and the muscular coats of the 
blood-vessels. The rapid pulse, when it occurs, is probably due to a 
depression of the peripheral ends of the vagus nerves. 

In the frog digitalis causes, when given in full doses, systolic 
arrest of the heart, but in man the arrest is in diastole. 

If a patient who has taken a poisonous dose be suddenly raised up, 
he may drop dead, owing to the disturbance of the contraction-wave in 
the heart produced by the erect posture. Under these circumstances 
the heart beats so abortively that the circulation fails. 

Respiration. — Digitalis has almost no effect on this function unless 
the amount be poisonous, when respiration is slowed. 

Temperature. — Upon the normal bodily temperature digitalis has 
little or no effect in medicinal dose. In poisonous dose it lowers tem- 
perature. In fever the drug seems to cause a slight fall with some con- 
stancy, but it can rarely be used for any antipyretic influence. High 
temperatures prevent digitalis from slowing the pulse, because, as 
proved by Brunton and Cash, fever depresses the vagus centres in the 
medulla, and also in all probability, when the temperature is very high, 
the peripheral ends of the vagus. This is an important point to be 
remembered in the therapeutic use of this drug. 

Kidneys, Tissue-waste, and Elimination. — Digitalis has almost 
no effect upon the kidney structure itself, and does not to any extent 
stimulate the renal epithelium. The cause of the increased urinary flow 
produced by digitalis in cases of cardiac dropsy depends upon the 
removal of congestion of the kidneys and the increased arterial pres- 
sure and improved circulation brought about by the drug. 

1 1 is important to remember that digitalis, if given in overdose, may 
cause a spasm of the blood-vessels of the kidney, and so cause suppres- 
sion of urine. This is usually followed by the development of cumula- 
tive effects. 

Upon tissue-waste digitalis seems to have little effect, but there is 
still some discrepancy in the reports as to the amount of urea cast off 



DIGITALIS. 215 

under its use, some investigators saying it is increased, others that it 
is diminished. 

We do not know how the drug is eliminated, as chemists have 
never been able to find it in the urine. It is probably oxidized in 
the body. 

Poisoning. — The slow, full pulse, followed by the hobbling, dicrotic, 
shuttle-like pulse-beats, and the angry, tumultuous cardiac beat against 
the chest-wall, aiford a combination of symptoms characteristic of the 
over-action of digitalis. The pulse may be full and slow when the 
patient is lying down, but at once becomes irregular on his sitting up. 

As the poisoning progresses vomiting may come on, exophthalmus 
occurs, and a peculiar blue pearliness of the sclerotic coat of the eye 
is seen. Consciousness is generally preserved nearly to the last. 
Death from digitalis poisoning may be put off for days or occur in 
two hours or even less. Headache is often a severe symptom. 

Treatment of Poisoning. — Tannic acid is to be given as a chem- 
ical antidote ; emetics and the stomach-pump are to be used, the former 
only when the drug has not yet been absorbed, for if the heart is much 
affected emetics are dangerous. External heat is to be applied, particu- 
larly about the abdomen ; the maintenance of a horizontal position must 
be insisted upon and maintained for several days after active symptoms 
have passed by, for sudden death on sitting up has occurred. The use 
of tincture of aconite, as the physiological antidote, maybe resorted to. 

Therapeutics. — Much unfortunate misunderstanding concerning the 
action of digitalis has arisen, and, while some call it a circulatory stim- 
ulant, others think it a circulatory depressant. The first class base 
their belief on the signs of increased arterial pressure and cardiac power, 
the others on the fact that it slows and steadies an irritable, rapidly- 
acting heart, and they overlook the other signs. Digitalis is a car- 
diac stimulant, and not a depressant. The quieting of irritability by 
it is the quietness produced by the drink of whiskey or coffee taken 
by the pugilist before he enters the ring, to steady his nerves and 
make him firm. If digitalis is used to decrease arterial tension, its 
dose must be dangerously large. (See Physiological Action.) 

Digitalis is of value in all cases of cardiac disease where the con- 
dition is one in which the heart fails to do its proper amount of work. 
If simple hypertrophy or excessive compensatory hypertrophy exists, 
it is harmful. It is of less value in aortic regurgitation than in any 
other lesion, because the prolongation of diastole allows greater oppor- 
tunity for the blood to fall back into the ventricle, although in the 
second stage of this lesion, when the mitral orifice and valve are 
beginning to be affected, it is often very useful. In some instances 
of mitiul regurgitation the drug does harm by overdistending the 
auricle through ventricular stimulation, which results in an increase 
in the regurgitant flow, and we can never tell before trying it Avhich 
cases will be so affected. In cases where the heart is irritable, palpi- 
tation present, and indigestion not the cause of the trouble, digitalis 
is of service. (See Heart Disease. 1 ) It is also useful in cardiac 

1 It is absolutely necessary for the student to turn to the article on Heart Disease, 
and to read it carefully, in order to understand the action of digitalis in disease. 



216 DRUGS.^ 

dilatation and asthenia — that condition which DaCosta calls a tired 
heart. 

In the second stage of pneumonia if the heart is laboring and 
unable to do its work properly, digitalis is often invaluable (see Pneu- 
monia), and as a heart tonic during the course of exhausting fevers, in 
small doses, is of great service. In congestion of the lungs in the 
typhoid state it will drive out the blood from the part congested and 
relieve stasis, unless the temperature is so high that it cannot act. 

In cardiac weakness from collapse, injury, poisoning, or shock digi- 
talis is of service, particularly in aconite poisoning, in which it is the 
physiological antidote. Owing to the slowness of its action it should, 
however, be preceded by ammonia and alcohol where the need is 
pressing. In muscarine poisoning digitalis and atropine are the anti- 
dotes. 

As a diuretic digitalis is most useful when the kidneys are congested 
and the circulation is sluggish from cardiac feebleness. When the renal 
structure is diseased other drugs should take its place, or it should be 
combined with more active renal remedies, such as squill or caffeine, or 
in very chronic cases of kidney trouble with compound spirit of juniper. 

As digitalis acts very slowly and maintains its effect for a long time, 
it may be given only once a day after its effects have been obtained, 
for the purpose of continuing its influence. 

Often when the patient has by error received too much of the drug 
the finger can scarcely note any pulse at the wrist, yet the ear when 
placed over the heart finds it to be beating wildly, as though it would 
break out of the chest. It is important that the weak pulse at the 
wrist be not taken as the only guide as to the state of the patient for 
this very reason, and the physician should always auscult the prsecor- 
dium before reaching an opinion as to the action of digitalis. 

Untoward Effects. — Digitalis sometimes causes nausea and indigestion 
by irritating the stomach. In children it is very apt to produce marked 
irregularity of the pulse. When it is given in full doses the patient 
should always be made to remain in bed and not allowed to sit up sud- 
denly, as syncope may occur. It is particularly important that this rule 
be enforced if the patient desires to empty his bladder, for cases are on 
record in which a patient has risen suddenly, emptied the bladder, and 
fainted or even died in syncope. 

In some cases a cumulative action occurs, which consists in a 
sudden development of the effects of the drug to an excessive 
degree, so that the symptoms resemble those seen after a poisonous 
dose has been taken. This is particularly prone to occur when 
ascites or dropsy is removed by tapping after the drug lias been taken 
for a long period. It is thought that the sudden withdrawal of pres- 
sure upon the great vascular trunks of the body-cavities causes the 
absorption of the drug with the juices of the tissues where it has 
remained inactive. Such an accident also sometimes occurs when a 
fever ends by crisis and digitalis has been given. It also takes place 
whenever full doses are given so frequently as to be in excess of elimi- 
nation, for the drug is slowly eliminated, and so rapidly accumulates in 
the body. Cumulative action is often preceded by a scanty passage of 



DIGITALIS. 217 

urine. A decrease in the quantity of the urine when digitalis is being 
used should cause the physician to stop its administration or be most 
cautious in its continuance. 

Contraindications. — In cases of marked atheroma of the blood-ves- 
sels, in aneurism and apoplexy digitalis is a dangerous drug, because it 
raises arterial pressure, and it is because of this effect that it is harmful 
in the presence of arterial excitement. In fatty degeneration of the 
heart the remaining healthy muscular fibres of this organ are, it is 
true, stimulated by the drug, but at the same time it also increases 
arterial tension to such an extent as to increase the labor of the 
failing heart. 

Administration. — The official preparations of digitalis are the tinct- 
ure (Tinctura Digitalis, JJ. S. and B. P.), dose 5 to 20 minims 
(0.32-1.3); the infusion (Infusum Digitalis, U. S. and B. P.), 1 to 4 
drachms (3.0-16.0) ; the fluid extract {Extr actum Digitalis Fluidum, 
U. S.), dose 1 to 4 minims (0.05-0.2); the extract (FJxtr actum Digi- 
talis, U. S.), J of a grain (0.015) ; and the powdered digitalis leaves 
[Digitalis Folia, B. P.), dose 1 to 4 grains (0.05-0.2), generally given 
in a pill. 

Some choice should be exercised in the use of the various prepa- 
rations made from digitalis leaves, because the different active ingre- 
dients of the drug possess different solubilities and exert different 
effects on the circulation, Thus digitalin, digitoxia, and digitalein 
all act as powerful stimulants to the heart muscle. Digitalin also 
stimulates the vagus peripherally and centrically. All three of these 
raise arterial pressure by stimulating the vasomotor system periph- 
erally and centrically. Digitonin, on the other hand, does not stim- 
ulate the heart muscle, but rather depresses it. It also depresses the 
vagus and thereby somewhat antagonizes the digitalin, 1 digitoxin, and 
digitalein. 

If we now turn to a consideration of the solubilities of these prin- 
ciples, we can readily explain the different effects produced by the 
infusion and tincture or fluid extract. Digitonin is soluble in water, 
as is digitalein ; but digitalin is only slightly soluble and digitoxin is 
scarcely at all soluble in water. As a result, the use of the infusion 
in a case of heart disease would not give the patient the same degree 
of cardiac power as the use of the tincture, for not only would the 
most powerful stimulant of all to the heart, vasomotor system, and 
vagi — namely, digitalin — be present in small amount, but in addi- 
tion the large proportion of digitonin would antidote it. On the 
other hand, digitonin is sparingly soluble in alcohol, while digitalin 
and digitalein are readily soluble in it, digitoxin being slightly so. 
It would seem, therefore, that in the presence of a failing heart and 
circulation the tincture and the fluid extract are the preparations 
greatly to be preferred to the infusion, because they contain large 
amounts of the active stimulant ingredients. 

The reason that the infusion acts efficiently as a diuretic in some 

1 By digitalin, reference is made to that prepared by Merck, and sometimes called 
the digitalin of Schmiedeberg, and not the amorphous form of Homolle nor the crys- 
talline digitalin of Nativelle- 



218 DRUGS. 

cases probably depends upon the fact that as it does not contain so 
much digitalin it is less apt to cause spasm of the renal vessels ; 
but if the heart is feeble and there is renal stasis, the tincture is 
probably the better preparation to overcome this state, because it both 
aids the heart and by contracting the renal vessels overcomes the 
stasis. The use of digitalin is inadvisable, unless we are sure that we 
get that made according to the process of Schmiedeberg, for the other 
digitalins usually sold are very uncertain. The infusion is far more 
apt to disorder the stomach than the fluid extract or tincture, because 
of the irritating digitonin. The dose of digitalin, which ought not to 
be used as a substitute for digitalis, is -fa of a grain (0.001). 

When digitalis cannot be swallowed it can be given hypodermi- 
cally in the form of the tincture, or its absorption can be brought 
about by the use of a poultice made by placing some digitalis leaves 
in a small bag and steeping it in hot water. The bag is then placed 
over the loins. This treatment must be cautiously employed to avoid 
poisoning. 

Attention has already been called to the necessity of using a prepa- 
ration which has been subjected to a physiological test by the manu- 
facturer before it is placed on the market. This is important because 
the crude drug varies so greatly in strength that even the most careful 
pharmacist cannot be sure that each lot of leaves is of equal medicinal 
strength, and chemical analysis of its complex make-up is practically 
impossible. Often when a patient has been taking an ordinary prepa- 
ration of digitalis without gcod results the writer has seen the use of a 
physiologically tested and active preparation do much good. 

DIURETIN. 

(See SODIO-SALICYLATE OF THEOBROMINE.) 

DORMIOL. 

This drug is closely related to chloral, being a compound of chloral 
and amylene hydrate, and occurs as a colorless fluid, tasting somewhat 
like camphor and being slightly pungent to the oral mucous membrane. 
It is miscible with water, and is marketed in 50 per cent, watery solu- 
tion, which is further diluted by 4 additional parts of water when it is 
prescribed. It is used as a hypnotic, as its name indicates, and as a 
substitute for chloral, but is probably not so powerful as a sleep-pro- 
ducer. Its dose is ^ to 1 drachm (2.0-4.0) of the 10 per cent, solu- 
tion just named, which may be mixed with syrup of raspberry, or 
water, to dilute it if desired. 

DUBOISINE. 

Duboisine is the alkaloid of the leaves of Duboisia myoporoides, a 
plant of* Australia. The crude drug is little used in medicine, but 
duboisine sulphate is used as a mydriatic under the same conditions as 
i- atropine, and more largely still as a hypnotic in insanity, inter- 
changeably with hyoscine. The dose of duboisine sulphate hvpodcrmi- 
call v a- a hypnotic is fa to fa of a grain (0.0008-0.001). The clinical 



ELATERIUM. 219 

experience so far adduced would seem to indicate that it tends to de- 
crease urinary secretion and to disorder the digestion, producing at the 
same time a soapy taste in the mouth, with excessive dryness of the 
mucous membranes. Rarely it causes profuse salivation or sweating in 
those who have an idiosyncrasy to its use. In a large number of insane 
and hysterical cases De Montyel found its use was followed by vom- 
iting of part of the food, but the patients seemed to have no nausea. 
The sulphate has been used with much asserted success in the treat- 
ment of paralysis agitans. Usually the dose by the mouth for this pur- 
pose has been yJq- of a grain three times a day. Cividati and Grianelli 
assert that duboisine is useful in epilepsy, particularly in its psychic 
forms. 

ELATERIUM. 

Elaterium, B. P., is a sediment obtained from the juice of the 
Ecbdllium Elaterium, or squirting cucumber. It appears in small, 
easily-broken, thin, grayish-green flakes, and has a bitter taste. Ela- 
terium is not official in the TJ. S. P., but its active principle, elaterin 
(Elaterinum, TJ. S. and B. P.), is official. Notwithstanding this fact, 
the crude drug is largely used. 

Physiological Action. — Elaterium is a very decided irritant to all 
mucous membranes, and even to the fingers of those who handle it. 
Its chief effect when taken internally by man is to cause profuse 
watery stools, but for some unknown reason it rarely acts upon 
animals in this manner. 

Therapeutics. — This drug is the best hydragogue purge which we 
have, causing very large watery passages, but not producing much 
pain when used in proper dose. For this reason it is useful in the 
treatment of local serous effusions, as in pericarditis and pleurisy, and 
in dropsy and ascites or general anasarca. It ought never to be used 
in cases of marked exhaustion, and may be advantageously followed, 
soon after it acts, by alcoholic stimulants. In uramiia with dropsy it 
is thought to aid in the elimination of the uraemic poison by the 
bowel. In cerebral congestions or effusions the drug will often be of 
service by depleting the diseased vessels. 

In poisoning by elaterium the symptoms are those of violent gas- 
troenteritis, and must be treated accordingly. (See Gastro-enteritis.) 

Administration. — The dose of elaterium is ^ of a grain (0.01), 
given in a freshly-made pill. Elaterin is best given in the dose of 
from ¥ X q- to Jg- of a grain (0.002-0.004), as follows : 

R.— Elaterini . . gr. iv (0.2). 

Alcoholis . . f^iv (120.0).— M. 

Dissolve by gentle heat. 
S. — Half a drachm contains y 1 ^ grain (0.004), or one full dose. 

The official preparation of elaterin, the active principle of elate- 
rium, is Trituratio Elaterini, TJ. 8. (elaterin 1, sugar of milk 9), 
given in the dose of \ to 1 grain (0.03-0.06). The Pulvis Elaterini 
Oompositus, B. P. (elaterin 1, sugar of milk 39), is given in the dose 
of 1 to 5 grains (0.05-0.32). 



220 



DRUGS. 



Fig. 40. 



ERGOT. 

Ergota, U. S. and B. P., is derived from the spawn or mycelium of 
the fungus known as Claviceps purpura, which grows in the flower 
and replaces the grain in common rye, or Secale cereale. 

Many so-called active principles have been isolated by chemists, 
and named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. 
None of these represent the entire drug, the 
nearest in its approach being ergotin, and 
ergotin is not an isolated principle, but a com- 
bination of principles. Robert teaches that 
there are three principles — namely, ergotinic 
acid, cornutine, and sphacelinic acid — and 
that cornutine is a true alkaloid. Further, 
that it is upon this cornutine and sphacelinic 
acid that the chief activity of the drug de- 
pends. Tanret, on the other hand, denies the 
existence of cornutine as an alkaloid. 

Physiological Action. — Nervous System. — 
Upon the nervous system ergot exercises little, 
if any, effect. 

Circulation. — Ergot when injected into 
the circulation causes a primary fall of arterial 
pressure, followed by a rise. The dominant 
action is represented in the rise. This rise is 
due to a stimulation of the vasomotor centres, 
but the primary fall is caused by its direct 
depressant effect upon the heart-muscle, re- 
sulting from the direct contact of the drug en 
masse with the heart. If the dose be very 
large, the fall of pressure is never recovered 
from, and progressive paralysis of the vaso- 
motor apparatus and heart occurs. When given in medicinal doses by 
the stomach the drug causes a rise of arterial pressure, probably by an 
action on the vasomotor centre and the muscular coats of the blood- 
vessels. 

Uterus and Unstriped Muscular Fibre. — It has been com- 
monly taught that the contractions of the uterus produced by medicinal 
doses of ergot arise from the stimulating influence of this drug upon 
the muscular fibres of this organ ; and while this is probably the case, 
it is also a fact, as shown by the careful studies of Hemmeter, that the 
drug causes uterine contractions by stimulating the centres in the 
lumbar portion of the spinal cord which control this viscus. 

On tlie uterus ergot in full medicinal dose exerts its influence not by 
increasing the normal pains of labor, but causing a tetanic, tonic, 
unyielding uterine spasm which drives all before it. In very small 
doses ii may assist the normal contractions without causing them to 
become tetanic. 

Ergol acts as a stimulant to all unstriped muscular fibres. 

Acute Poisoning. — The symptoms of overdosing from ergot, when 




A, Ergot stimulates the ute- 
rine centres in the spinal 
cord, and B, the muscular 
fibres in the uterus itself. 



ERGOT. 221 

the effects are slowly produced, are sometimes great hunger or craving 
of food, at other times nausea and vomiting. If the poisoning is quite 
severe, there are great restlessness, headache, delirium, and coldness 
of the surface of the body. 

Chronic Poisoning. — Two forms of poisoning from the prolonged 
use of ergotized rye bread sometimes occur. One is characterized by 
spasmodic muscular contractions, the other consists in the formation 
of gangrenous sloughs. In the first of these forms it is not very un- 
common for cataract to develop, and it is stated that the spasms are 
due to the influence of one of the principles of ergot — namely, cornu- 
tine. 

Therapeutics. — Ergot is given to parturient women for the preven- 
tion or arrest of post-par turn hemorrhages. For the prevention it should 
be given to the woman by the mouth just- as the head of the child is 
about to slip over the perineum, and not before, but in the majority 
of instances its use is needless. When administered to stop a hemor- 
rhage already flowing, the doses should be large, as much as 1 to 2 
drachms (4.0-8.0) of the fluid extract or 1 wineglassful (30.0) of the 
wine of ergot. The drug should produce its effects in about fifteen 
minutes, and may be repeated every fifteen minutes till it acts. The 
action lasts about half an hour. Ergot should not be given in the early 
stages of labor, but this rule may, under certain conditions, be modi- 
fied. If uterine inertia comes on in the course of a normal labor, 
which cannot be overcome by the use of coffee or kola, or other nerve- 
stimulant, a small dose of ergot may be employed. Such a small dose 
does not cause a constant tetanic uterine contraction, but simply brings 
on the "to-and-fro" movements. By a "small dose" the writer means 
from 5 to 20 minims (0.35-1.3) of the fluid extract. Caution must be 
used even with this dose. 

If the birth-canal is obstructed, ergot should never be employed, 
and, unless the os uteri is well dilated, should not be given in any 
dose. 

In post-partum hemorrhage of a severe character it may be well to 
give a solution of the aqueous extract of ergot hypodermically. The 
extract should be rubbed with the proper amount of water (parts 1 to 
5), and filtered through a fine aseptic handkerchief to get rid of foreign 
bodies before it is injected. 1 

When ergot is given care should be taken that the uterine cavity is 
clear of all clots or placental fragments, lest the closure of the os uteri 
under the influence of the drug imprison these harmful materials. 

According to many obstetricians, whose results have been confirmed 
by a number of special studies, ergot in moderate doses very distinctly 
aids in overcoming subinvolution of the uterus. 

In hemorrhages from the lungs and kidneys or other unapproach- 
able parts ergot is thought by some to be very useful when given by 
the mouth, but it is probable that it rarely achieves any real good. 

1 Under the name of "Ergot Aseptic" there is dispensed in sealed and sterile glass 
bulbs a concentrated preparation of ergot for hypodermic use. Each bulb holds one 
dose, and the drug is drawn directly from it into the syringe. This is a most useful 
preparation. 



222 DRUGS. 

Particularly is this the case in pulmonary hemorrhage, since the vaso- 
motor system practically does not exist in the pulmonary vessels, and 
the increased pressure caused by the ergot in the general systemic cir- 
culation may increase the pulmonary leakage. The truth is, that in pul- 
monary hemorrhage very little real good can be obtained by internal 
medication. 

In epistaxis, menorrhagia, and metrorrhagia, and in some cases of 
night-sweats, ergot is of service. In hypostatic, pulmonary, and other 
congestions it is useful, particularly if employed with digitalis. 

In dysenteries with bloody stools and in serous diarrhoea ergot some- 
times does good. 

Some persons suffer from vertigo associated with hyperesthesia of the 
scalp and headache. Relief can often be obtained in such cases by the 
use of 20 minims (1.3) of the fluid extract of ergot and 5 to 10 grains 
(0.35-0.65) of bromide of potassium three times a day. 

Ergot has been used very largely in the treatment of uterine fibroids 
as an expulsive remedy and cure. It is only of value in those cases 
where the growths are just beneath the mucous membrane. By the 
contractions of the uterine muscular fibres the blood-supply of the growth 
is decreased, the recurring hemorrhages cease, and the tumor is finally 
expelled, having really sloughed out of its bed. This method is far 
inferior to the knife, and very painful and prolonged. Large growths 
cannot be so treated. Ergot is sometimes useful in the treatment of 
bleeding hemorrhoids, and it has been given with success in diabetes 
insipidus, when it is well to combine with it the bromide of sodium. 

Administration. — Ergot is official as the fluid extract (Extractum 
Ergotce Fluidum, U. S., Extractum Ergoto? Liquidum, B. P.), dose 
| to 1 drachm (2.0-4.0). The wine (Vinum Ergotce) is given in 
the dose of 4 to 8 drachms (16.0-30.0). Bonjean's ergotin is made 
by a special process, and it or the solid extract can be given hypoder- 
mically in the manner already described. The B. P. preparations are 
the solid extract (Extractum Ergotai), which is given in the dose of 
5 to 20 grains (0.35-1.3), and Infusum Ergota>, 1 to 2 fluidounces 
(30.0-64.0). Injectio Ergotai Hypodermica, B. P., is given in the 
dose of 3 to 10 minims (0.15-0.65) by subcutaneous injection. The 
B. P. also recognizes an ammoniated tincture of ergot (Tinctura 
Ergotai Ammoniata). Ergotin (Erqotinuni) is given in the dose of 
2 to 5 grains (0.1-0.32). 

As ergot is a drug that varies greatly in its physiological activity in 
its crude state, and cannot be chemically assayed with advantage, the 
physician should always use a preparation which has been physiolog- 
ically tested by the manufacturer before it is placed on the market. 
This may be done by studying its effect on the uterus of a pregnant 
animal, or by giving it to animals and observing its effect on the calibre 
of the small vessels. If the drug is active, it causes stimulation of the 
muscular coats of the vessels; and if its use is persisted in, it finally 
occludes them. Houghton has shown that an active ergot will cause 
gangrene of the rooster's comb if it is given constantly. Inert ergot 
will not do this. (See Plate V.) Much credit is due to Houghton for 
having perfected this valuable pharmacological test. 



PLATE II. 




Showing Shrivelling and Dry Gangrene of Rooster's Comb pro- 
duced by the action of an active specimen of Ergot on the 
Capillaries, thereby cutting off the Local Blood 
Supply. The central figure shows the nor- 
mal comb. (After E. M. Houghton.) 



ETHER. 223 



ERIGERON, or PLEABANE. 

Oil of Erigeron {Oleum Erigerontis, U. S.) is a yellowish volatile 
oil of a peculiar, not bad, taste, closely resembling turpentine, which is 
distilled from the fresh, flowering herb of Erigeron canadense. It is by 
far the best medicinal remedy which we have for the treatment of pas- 
sive uterine oozing, or a "show," as it is sometimes called. 

In epistaxis and other hemorrhages of moderate degree it is quite 
useful. In some instances it is used in place of copaiba and cubebs 
in the later stages of gonorrhoea. It is best given in capsule or on 
sugar in the dose of 10 to 30 minims (0.65-2.0) after meals, or oftener 
if needed. 

ERYTHROL TETRANITRATE. 
(See article on Nitroglycerin.) 

ETHER. 

Sulphuric ether is official as JEtlier, U. S. and B. P., and in the 
U. S. Pharmacopoeia of 1880 was called JEther Fortior. Pure Ether 
(^Ether Purificatus, B. P.) is practically free from alcohol and water. 
Ordinary ether is not generally used as an anaesthetic, but for the abstrac- 
tion of oils and for other pharmaceutical purposes. Ether is made by 
the action of sulphuric acid on ethylic alcohol, and is sometimes called, 
in consequence, ethyl oxide. Ordinary ether contains about 74 per 
cent, of ethyl oxide and 16 per cent, of alcohol, with a little water. 
On the other hand, the stronger or official ether contains about 96 
per cent, of ethyl oxide and only 4 per cent, of alcohol, with water. 
Both preparations boil when held in a test-tube if a piece of broken 
glass is added to the liquid. The stronger ether boils much more 
vigorously than the weaker under these circumstances. 

Ether possesses a peculiar penetrating odor, a hot burning taste, 
and is a colorless, volatile, and very inflammable liquid. For this 
reason it should never be held near a fire or light, and, as its vapor 
is heavier than air, any fire in the room should be above the patient, 
not below him. No flame should be held nearer to the ether than five 
feet. 

Physiological Action. — The action of ether on the animal organism 
is very rapid and powerful, but temporary. Except for the rapidity of 
its effects it is very much like that of alcohol. When applied to the 
skin, it causes intense cold by its evaporation, and may be used in the 
form of a spray to benumb or locally freeze a part. 

Upon mucous membranes ether as a liquid or in vapor acts as an 
irritant, and causes, when its vapor is first inhaled, great irritation of 
the fauces and respiratory tract, so that temporary arrest of respiration 
is not uncommon. The face becomes suffused and red and the conjunc- 
tiva injected. Owing to these conditions the patient often is restless or 
or struggles to get his face away from the vapor, but a stage of quiet 
soon succeeds this primary stage of struggling. During this period of 
quiet the breathing is generally full and deep and the pulse rapid but 



224 



DRUGS. 



strong, while the ocular reflexes are at its beginning intact. Following 
this stage a second period of restlessness or struggling comes on, in 
which the patient may become absolutely uncontrollable except by 
brute force. Yelling, shouting, cursing, or laughing and crying, may 
be prominent symptoms, and the individual is pugilistic, caressing, or 
ill-tempered, according to his temperament. If 'the drug is now pushed, 
a condition of total anaesthesia is soon attained, and quietude takes 
the place of the struggles. This is the time for the operation to be 
carried on, for if it is attempted in the earlier stages the struggles of 
the second stage prevent any operative procedures. (See Therapeutics, 
below.) It is not proper to push the drug till the muscular relaxation 
amounts to complete flaccidity, as this endangers the respiration. 

Nervous System. — In producing its effects, ether acts first on the 
brain, then on the sensory tracts of the spinal cord, then on the motor 
tracts, then on the sensory side of the medulla oblongata, and finally 
upon the motor side of the medulla, and thereby produces death from 



Fig. 41. 




Ether produces anaesthesia by depressing the perceptive areas in the brain A. Later it 
depresses the intellectual areas B and the motor areas C. After this the sensory paths in 
the spinal cord are depressed D, and finally the motor tracts in the cord E. 

respiratory failure if given to excess. Upon the nerve-trunks it exerts 
no effect unless it is directly applied to them. Ether does not produce 
anaesthesia by influencing the blood, coagulating the protoplasm of the 
nervous system, or by any other destructive influence. It simply puts 
aside, for the time being, the vital functions of the parts affected by it. 
Circulation. — Ether is one of the most diffusible and rapidly act- 
ing cardiac stimulants which we possess, and is correspondingly fleeting 
in its effects. It increases the pulse-rate and force by stimulating the 
heart and the arterial pressure by increasing the activity of the vaso- 
motor centres. In overdoses it acts as a cardiac depressant, but only 
when the amount is very large. Upon the blood, my colleague, J. 
Chalmers DaOosta, has shown that ether, when given by inhalation, 



ETHER. 225 

decreases the haemoglobin richness of each corpuscle, although there is 
an apparent increase in the number of the corpuscles themselves, par- 
ticularly in those persons who are already somewhat anaemic. 

Respikation. — As already stated, when ether is first inhaled it 
often causes an arrest of respiration. According to Kretzschmar, this 
is due to an irritation of the trifacial nerve, which causes a reflex spasm 
of the glottis, and not to irritation of the peripheral vagi in the lungs. 
This is only partly true, for the author has proved that section of the 
vagus nerves prevents this occurrence, so that both the vagal and tri- 
geminal irritations are responsible for the arrest. 

In patients under ether the movement of the diaphragm is an 
exceedingly interesting study, for before the condition known as sur- 
gical anaesthesia is developed, while there is still some rigidity and 
the throat reflex is riot completely abolished, the contractions of the 
diaphragm are frequently so violent that unless the laryngeal open- 
ing be absolutely free the intercostal spaces are depressed and the 
abdominal contents thrust violently downward and outward. Just so 
soon, however, as the chin is pulled forward and a free access of air 
is allowed, the abdominal displacement, though it is still present, is 
not so great, and the chest movement is no longer reversed. As the 
ether is pushed the respiration becomes purely thoracic, the dia- 
phragm no longer taking part in the respiratory cycle, or becoming 
so relaxed that it allows the chest on expansion to aspirate the 
abdominal viscera upward, as is shown by the retraction of the belly- 
walls at a time when they should normally expand with the thorax 
in inspiration. This observation would seem to point to the fact that 
the primary stimulant action of ether upon the respiratory apparatus 
is particularly felt by those centres which govern the movements of 
the diaphragm, and that, as this is the case, these centres later on are 
the first to feel the paralyzing effect of still larger amounts of the 
drug. 

These facts give us, therefore, a danger-signal during the adminis- 
tration of ether, and the integrity of the diaphragmatic function, as 
represented by the movement of the belly-walls, should be as care- 
fully observed as are the thoracic excursions, the character of the 
pulse, or the condition of the pupil. The rule may therefore be laid 
down that when the diaphragm ceases to act anaesthesia has been 
carried to its extreme legitimate limit, and that the use of an anaes- 
thetic after this time must be carried on with the greatest care and 
watchfulness. 

The diaphragm is the first part of the respiratory mechanism to 
yield to respiratory paralysis. In death from any cause the progress 
of failure of respiration will, in the vast majority of cases, be denoted 
by a failure on the part of the diaphragm primarily, with compensa- 
tory excursions of the chest ; and it is also to be noted that as the 
chest movements fail the accessory muscles of the neck come into 
play. These muscles in time cease to act, the hyoidean group lose 
their point cVappui, the chest remains motionless, the lower jaw is 
dropped, and the scene is closed by a few gasps in which the muscles 
of the neck may be the chief factors. 

15 



226 DRUGS. 

Upon the respiratory centre ether acts as a powerful stimulant when 
used in ordinary amounts ; in overdose it paralyzes this part of the 
nervous system. 

Temperature. — Prolonged etherization lowers the bodily heat very 
greatly. That of the dog may be lowered some 9° F. in an hour if the 
drug be pushed, and as great a fall has been known as 4° F. in man. 
The fall is partly due to the depression of the nervous system and the 
chilling of the body and lungs by the evaporation of the drug. 

Elimination. — Ether escapes from the body by the lungs and 
kidneys. 

Untoward Effects. — Ether, while safer than chloroform, is not abso- 
lutely devoid of all dangerous effects. 1 Sometimes, when the drug is 
pushed too strongly, deep cyanosis with pulsation of the jugular veins 
shows deficient oxygenation of the blood and cardiac distention. In 
other, very rare, instances sudden cardiac failure has occurred or total 
arrest of respiration ensued. In nearly all cases of sudden death from 
ether grave kidney or heart lesions have been present, and have been 
found at the autopsy. Rarely the rise of arterial pressure which it pro- 
duces has caused apoplexy. 

The treatment of accidents during etherization consists in the 
withdrawal of the ether, the use of artificial respiration, and the 
placing of the body, if the face is pale, head downward. On the 
other hand, if the face is flushed and cyanotic it indicates respiratory, 
not cardiac, failure, and this position is not to be resorted to. The 
physician should also employ hypodermic injections of strychnine, 
atropine, and digitalis, or, more rarely, an intravenous injection of 
ammonia, which is more dangerous, but better than the others in a 
pressing emergency because it is more rapid in its action. Ether is 
often given hypodermically under such circumstances, and may occa- 
sionally do good, but its use is a bad practice, as, if the heart or respi- 
ration is already depressed by ether, the employment of still more of 
the drug simply makes matters worse. The cases in which such a line 
of treatment is followed by good results are those in which the failure 
of respiration is not due to a saturation of the body with ether, but to 
asphyxia produced by mechanical interference with free breathing, as, 
for example, the presence of mucus in the air-passages or a too close 
application of the towel to the face. In such cases the hypodermic 
injection of ether causes so much local pain and irritation as reflexly 
to call up respiratory movements, as well as to directly stimulate the 
respiratory centre to greater effort. 2 Alcohol ought not to be used if 
the other drugs named can be obtained, because alcohol is so nearly 
allied physiologically and chemically to ether. Frictions, hot appli- 
cations, and artificial respiration should be practised. (See article on 
Asphyxia.) 

The diaphragm being the most important muscle of respiration, the 

1 The mortality due to etherization is about 1 in 20,000; or, according to the com- 
bined Statistics of Jiillianl and Ormsby, in 407,553 Cases there were 2o deaths, or 1 in 
16,302. ( ( Jompare ( Ihloroform. ) 

\- consciousness is not necessary to the carrying out of a reflex action, this is 
perfectly possible and probable. 



ETHER. 



227 



physician should seek to stimulate it by resorting to Laborde's rhythmic 
traction of the tongue, which consists in rhythmically drawing this organ 
outward and upward from the mouth ten to. fourteen times a minute. 

As ether is at hand, it may be dashed on the chest and abdomen to 
cause inspiration by reflex action ; in lieu of cold water, which wets 
the clothes and does not evaporate rapidly. 

In some cases great nausea and vomiting follows the use of ether. 
This can generally be prevented by the avoidance of food before the 
operation (see Therapeutics), and by the administration of cracked ice 



Fig. 42. 




This figure illustrates how traction on the tip of the tongue draws the epiglottis away from 
the glottic opening and permits free ingress of air. It also shows how letting the tongue 
fall hack in the month in anaesthesia would close the air-passages and permit the epiglottis 
to interfere with breathing. For a full description see article on Asphyxia. (From a 
research by Dr. Martin and the author.) 

and small doses of acetanilicle and brandy after the operation. (See 
Vomiting.) This condition may also be avoided in many cases by 
giving oxygen gas with the anaesthetic. (See Oxygen, Important.) 
Severe bronchitis may occur in invalids and children after the inhala- 
tion of ether, and in many cases this is due more to the exposure than 
the drug. Pulmonary complications, while possibly due to the direct 
effect of the ether, are probably chiefly the result of the inspiration 
of particles of food, foul secretions from the mouth, and perhaps 
blood, into the lungs, the glottis being anaesthetized and unable to 
protect the lungs from the invasion of foreign matter. Great cleanli- 
ness of the mouth is essential before every operation, and care should 
be taken during and after the operation that profuse secretions are not 
inspirated. Total or partial anuria may develop after etherization, par- 



228 



DRUGS. 



ticularly after abdominal operations. This is a very dangerous symp- 
tom, which can sometimes be removed by giving nitroglycerin and 
a large rectal injection of normal saline solution. It has, however, 
been proved, both experimentally and clinically, that ether is not 
capable, in the ordinary patient, of producing renal disorder of any 
moment unless the kidneys are already diseased or the patient is soaked 
with the drug, as sometimes occurs when it is badly given. Weir 
asserts that ether is not dangerous even in those with moderately dis- 
eased kidneys. The use of ether in diabetic patients is dangerous ; 
the patient often never regains consciousness after its use. 

Not uncommonly after the use of ether in the case of an old person 
or a child the bronchial tubes so fill with mucus that there is danger 
of the patient drowning in his own secretions. A full dose of atropine, 
which checks secretion, given hypodermically, is useful at such times. 
Sometimes after an anaesthetic is given the patient is found to have 
a monoplegia. This is not due to the anaesthetic, but to pressure exer- 
cised upon the nerve supplying the part during the operation. It is 
a true pressure-palsy. 

Therapeutics. — Ether is used chiefly as an anaesthetic by means of 
inhalation. One method consists in forming a cone out of a towel 
and a piece of paper and placing a small sponge in its end. Upon 

this sponge the ether is poured, and the 
Fig. 43. large open mouth of the cone is placed 

over the face. If this be done suddenly, 
the sensation of suffocation is generally 
so great as to cause fright and strug- 
gling, which is inadvisable. The better 
way is to hold the cone at some distance 
from the face, and gradually bring it 
nearer as the effects of the ether are 
developed. After partial anaesthesia is 
attained the cone should be placed 
closely over the face and the vapor be 
pushed in as concentrated a form as 
possible, whereas when chloroform is 
used its vapor should be well mixed with 
a great amount of air. Care should be 
taken that the ether does not get into the eyes of the patient, either 
in vapor or liquid form, owing to the irritation which it will set up. 
To prevent this a piece of thin muslin wet with water will be found 
of service if placed over the eyes. A large number of ether-inhalers 
are employed in preference to the towel; the best is that known as the 
" Allis Inhaler," fitted with a web of muslin. (See Fig. 43.) (For 
the use of* oxygen with ether, see Oxygen.) 

When ether is to be given no food ought to be allowed the patient 
for twelve hours preceding its use, in order to avoid vomiting during 
and ;if'tcr the operation. The patient should not be allowed to retain 
any tobacco or false; teeth in the mouth, as either may slip into the 
larynx and cause death while the anaesthetic is being given. 

Under the name; of the A. C. E. mixture there is used a com- 




nhaler. 



ETHYL BROMIDE. 229 

pound of alcohol, chloroform, and ether, which is properly but rarely 
used in America. (See Chloroform.) 

Ether may be used as a local anaesthetic in an atomizer spray, owing 
to the cold produced by its evaporation when it strikes the skin. Thus 
it is particularly useful in cases where thoracentesis or paracentesis 
abdominis is to be performed, and also in cases of superficial neur- 
algia, where the benumbing of the nerve often effects a permanent 
cure. 

Internally, by the stomach, ether is very useful in colic, although 
for flatulence of adults and children Hoffmann's anodyne is a more 
efficient remedy. In cases of collapse ether given by means of the 
hypodermic needle or by the stomach is of great service, particularly 
when cardiac action is very feeble, and it will give relief by inhalation 
in some of these cases more rapidly than the nitrite of amyl. 

In hiccough a few inhalations of ether will often stop the spas- 
modic movements, and other local muscular spasms can be relieved in 
this way. 

Large doses of ether given by the mouth or hypodermically have 
been highly recommended in the treatment of uramiia. They are 
most serviceable in the forms in which cardiac and respiratory com- 
plications are marked. 

Ether may be used by inhalation to produce muscular relaxation 
when the surgeon desires to reduce a strangulated hernia by taxis. 

In cases where cod-liver oil cannot be digested ether may be given 
in 20-minim (1.30) doses in ice-water or capsule, either with the oil, or 
some minutes after it is taken, to aid in its digestion and absorption. 

Internal Administration. — When used internally, ether should be 
given in ice-cold water, or, better still, in capsules, in the dose of 30 
minims to ^ an ounce (2.0 : 15.0). If cold water is not used to dilute 
it, so great is the irritation of the fauces produced by the fumes of the 
drug that deglutition is impossible. 

The B. P. recognizes a spirit (Spiritus ^Etheris) given in the dose 
of 1 to 2 drachms (4.0-8.0). 

Contraindications. — Ether should not be used by inhalation in bron- 
chitis or acute nephritis, because of its irritant properties ; in perito- 
nitis or gastritis, because it is apt to induce vomiting ; in aneurism or 
in the presence of marked vascular atheroma, because it may rupture 
a blood-vessel by raising arterial pressure, nor in diabetes, lest it pro- 
duce diabetic coma ; and if anaemia is present and an examination of 
the blood shows that the haemoglobin is below 50 per cent., the use of 
the drug should be avoided if possible. 

ETHYL BROMIDE. 

Bromide of Ethyl id obtained by distilling a mixture of alcohol, 
sulphuric acid, and bromide of potassium, and is a colorless fluid of 
neutral reaction, having a pleasant odor resembling chloroform. It 
evaporates with great rapidity, and any sample which does not do 
this is to be discarded. Poured on the hand, it should leave no fatty 
feeling. It should be remembered that the drug is decomposed by 
sunlight and when in contact with the air. In the presence of lamp- 



230 DRUGS. 

light the fumes form bromal hydrate and bromine. The drug should 
be kept in dark -glass bottles. The physician should distinctly sepa- 
rate in his mind bromide of ethyl from bromide of ethylene. The 
latter is a chemical product possessing very dangerous properties, and 
should never be used in medicine. There is reason to believe that 
unfavorable symptoms follow the use of bromide of ethyl only when 
the drug is impure or is improperly used. 

Physiological Action. — According to the studies of Thornton and 
Meixell in the author's Laboratory at the Jefferson Medical College, 
the dominant action of the bromide of ethyl is on the respiratory, not on 
the circulatory, system. This effect is depressant, but this influence is 
only met with after excessive doses. The blood-pressure falls under its 
influence to a slight degree, and the pulse is slowed through an influence 
probably exercised on the inhibitory nervous mechanism of the heart. 

Therapeutics. — Bromide of ethyl is a useful anaesthetic for short 
operations, such as opening boils or abscesses, or for the relief of the 
pain in other brief surgical procedures. Originally introduced into 
general use in this country by Levis, it has been found unsuited to 
major surgical cases, because if continued for a long time it seriously 
depresses the respiration. Bromide of ethyl has been found of the 
greatest value by Montgomery, of Philadelphia, as an anaesthetic in 
labor and for minor gynecological operations in office practice. He 
finds that the patient may be allowed to inhale the drug from a Haw- 
ley inhaler, for as soon as she has had enough to produce anaesthesia 
the inhaler drops from her hand. The patient is also more obedient 
to the physician's directions, because of the fleeting influence of the 
drug, than when chloroform or ether is taken, and post-partum hemor- 
rhage through uterine relaxation is not so apt to occur. 

A very great advantage possessed by bromide of ethyl is the 
rapidity of its action. A few whiffs are generally all that is needed 
to cause anaesthesia. It rarely produces disagreeable effects. Cases 
of sudden death under its use are, however, on record, and in some 
instances nervous twitchings, and even tetanic spasms, have been 
known to follow its employment. These tetanic symptoms are, how- 
ever, fleeting and generally of little importance. Nausea and vomit- 
ing rarely follow its employment, but it is apt to leave an unpleasant 
garlic-like taste in the mouth, and a similar odor of the breath is 
frequently noted for several days after its use. 

Administration. — Bromide of ethyl should be administered for but 
a brief period, but when taken should be inhaled freely. It cannot 
be given carelessly with good effect. If a good sample is employed, 
4") minims to 3 drachms (3.0-12.0) is a sufficient amount to induce 
anaesthesia. This quantity should be used at once, instead of added to 
the inhaler drop by drop, as in the case of chloroform, and the cloth or 
inhaler should be held close to the mouth and nose, instead of at a little 
distance, as is often necessary with other anaesthetics. 

ETHYL CHLORIDE. 

Ethyl chloride is a liquid of a strong ethereal odor, made by the 

action of hydrochloric acid upon ethylic alcohol. It is used, as is 



ETHYL CHLORIDE. 



231 



methyl chloride, for the purpose of producing anaesthesia by freezing 
the part of the body against which it is brought in contact. This 
liquid is used not only as a local anaesthetic by virtue of its freezing 
properties, but also by inhalation. It is necessary when it is given by 
inhalation, because of its great volatility, that it should reach the 
patient in concentrated form, and not have an opportunity to be dis- 
sipated into the surrounding air without first enter- 
Fig. 44. ing the lungs. For this reason it should be used 

by the aid of a mask such as that employed in the 
administration of nitrous oxide gas. The mask 
should be applied in such a way as to tightly cover 

Fig. 45. 



40 




30 




The cap unscrews and 
the drug escapes as a 
fine spray through a 
small hole in the end 
of the glass. 




Showing use of a glass funnel as an inhaler for ethyl chloride. 



the nose and mouth, and the ethyl chloride is then projected on to a 
compress which is placed inside of it. Where it is impossible to 
obtain an inhaler made for this purpose, a tin or glass funnel may be 
used as a substitute. The large end of this may be placed over the 
mouth and nose, the neck of the funnel containing absorbent cotton. 
Through the small end of the funnel the chloride of ethyl is sprayed 
against the cotton. By the careful adaptation of the hands to the 
sides of the funnel and the cheeks it is possible to make this a very 
close inhaler. A good way to keep ethyl chloride is in the form of a 
graduated glass container so constructed that the drug is measured as 
the spray is forced from it by the heat of the hand. The drug is placed 
upon the market for this purpose in graduated glass containers, under 
the name of ; ' Kelene." Anaesthesia produced by this method usually de- 
velops within a very few moments, and it is claimed that there are very 
slight changes in the pulse and respiration under its influence. 1 or 2 



232 DRUGS. 

drachms (4.0-8.0) of ethyl chloride are usually sufficient to produce 
an anaesthesia lasting from five to ten minutes. Larger amounts than 
this may be employed when a longer anaesthesia is desired. It is a 
noteworthy fact that the pupillary and corneal reflexes are not lost 
under its influence except in children, and this drug cannot be used 
as an anaesthetic where muscular relaxation is indispensable. After 
the mask is removed, the patient rapidly recovers consciousness and 
often experiences no unpleasant symptoms, although vomiting may 
occur in some cases. The disadvantage of this form of anaesthesia 
is its cost. How safe it is we do not know. In 2550 cases recorded 
by Lotheisen 1 death occurred under its effects, but this may have 
been due to organic disease of the coronary arteries, which was present. 

ETHYL IODIDE. 

This is a colorless, non-inflammable liquid, which really should be 
called hydriodic ethyl. Ethyl iodide must be kept in dark-colored 
bottles in a dark place to prevent it from undergoing decomposition. 
It is very volatile, and the fumes arising from it are slightly pungent, 
but not irritating in ordinary amounts. Unfortunately, the odor is 
disagreeable to most persons. 

Physiological Action. — Very little is known of the general physio- 
logical action of iodide of ethyl, and the drug would be a good one for 
laboratory investigation. It does not produce anaesthesia except in 
very large amounts. 

Therapeutics. — Iodide of ethyl is used in medicine entirely by 
inhalation for the treatment of subacute or chronic catarrh of the air- 
passages and for the purpose of rapidly impressing the system with 
iodine for alterative purposes, for it is the iodine in the remedy which 
produces the curative effects desired. In catarrhal states of the bron- 
chial tubes the stimulating effect of the iodine is supposed to cause 
free secretion and to prevent abnormal thickening of the mucus and 
dilatation of the air-passages. For this reason iodide of ethyl is sup- 
posed to be of service in asthma and its resulting emphysema. Very 
recently Bartholow has recommended this drug in the treatment of 
pneumonia. It is said by that writer to be particularly useful in the 
later stages of this disease, to aid in producing resolution, but the 
author lias never seen it produce much effect. (iSee Inhalations.) 

Administration. — 10 to 20 minims (0.65-1.3) may be placed upon 
a handkerchief and inhaled, or a small vial filled with the drug may 
be held in the hand under the nostrils. Under these circumstances 
the heat of the hand sets free the necessary amount of vapor. 

EUCAINE HYDROCHLORATE. 

Eucaine hydrochlorate is a synthetic substance having a chemical 
formula closely resembling that of cocaine. The drug is now mar- 
keted as a substitute for cocaine, it being claimed that it does not 
affeel the hear! as docs the latter drug. Eucaine does not cause a 
primary contraction of the blood-vessels when locally applied, as does 



EUCALYPTUS. 233 

cocaine, but a hyperaemia of the parts affected. Two forms of eucaine 
have been used, eucaine " A " and eucaine "B " ; but the latter is now 
employed for ordinary local anaesthesia, and for use in ophthalmic and 
genito-urinary surgery, as it is less irritating. Used by the process 
for producing infiltration anaesthesia (see Cocaine), eucaine causes con- 
siderable pain before acting as an anaesthetic. For this purpose it 
should be used dissolved in the following formula and warmed before 
being injected : 

R. — Beta-eucain gr. j (0.06). 

Sodii chloridi gr. x (0.65). 

Aquae destillat fgiij (90.0). 

In ophthalmic practice it is employed in 2 per cent, solution, and to 
ordinary mucous membranes in 5 per cent, solution — that is, 25 grains 
(1.6) to the ounce of water. One advantage of eucaine is that it 
forms a permanent solution with water in 3J per cent, strength. 
Further, eucaine solutions can be boiled and thereby sterilized before 
they are used without causing decomposition of the drug. 

Recently Beta-eucaine acetate has been introduced to take the 
place of the hydrochlorate, as it is very much more soluble, namely, 
to the extent of 33 per cent. 

Eucaine hydrochlorate possesses a distinct disadvantage in its 
inability to cause primary contraction of the blood-vessels when 
locally applied, and this effect of cocaine is often most valuable to 
overcome local engorgement. Further, it causes severe smarting 
pain when dropped into the eye. Eucaine is also capable of pro- 
ducing internal effects resembling those due to overdoses of cocaine, 
and these must be treated by the use of strong coffee, alcohol, digi- 
talis, and strychnine. If the case is pressing ether, ammonia, and 
nitroglycerin may be used as rapidly acting stimulants. 

EUCALYPTUS. 

Eucalyptus , U. S., is the leaves of the Eucalyptus globulus, or 
Blue-gum tree, a native of Australia, but grown at present all over the 
world. Its chief medicinal constituent is the oil of eucalyptus (Oleum 
Eucalypti, U. S. and B. P.), from which is derived Eucalyptol, U. S., 
which is a camphoraceous body obtained by redistillation with caustic 
potash or chloride of calcium. The oil of eucalyptus and eucalyptol 
are used for the same purposes, but the latter is the refined product 
of the former. 

Physiological Action. — Locally applied, the oil is a decided irritant. 
10 to 20 minims (0.65-1.5) taken internally cause slight stimulation, 
followed by a sense of calm ; while larger doses produce disturbed diges- 
tion and loose, oily-odored stools. The pulse is increased in frequency 
and force, and intense headache may come on. After very large 
doses there is a fall in pulse-force, bodily temperature, and strength 
of limb, and the respirations are decreased. A peculiar loss of sen- 
sation in the lower limbs may occur. If death takes place, it is due 
to respiratory failure. The drug is eliminated by the skin, kidneys, 



234 DRUGS. 

bowels, and lungs. The urine may have the odor of violets, as it 
sometimes does after the use of oil of turpentine. 

The oil of eucalyptus has considerable antiseptic power. 

Therapeutics. — Eucalyptus is used in malarial fever where quinine 
cannot be had, nor be borne by the patient owing to idiosyncrasy. In 
bronchitis, in an emulsion or in capsule, it is of great value in the later 
stages (see Bronchitis), since in its elimination by the lungs it acts 
locally upon the inflamed mucous membrane, and it may be used in the 
subacute forms of gonorrhoea in the same manner. The following pre- 
scription will answer : 

B .—Olei eucalypti f^j (4.0). 

Olei amygdalae dulc f£j (4.0). — M. 

Ft. in capsule Xo. x. 
S. — One t. d. after meals. 

Oil of eucalyptus is very useful in some forms of rheumatic head- 
ache or in headache dependent upon malarial fever. 

Eucalyptoh U. S., is obtained from oil of eucalytus, and is largely 
employed by rhinologists and others in lotions and other nasal appli- 
cations It may be used in solutions of fatty oils, but is insoluble in 
water, although it is soluble in alcohol and ether. 

Administration. — The fluid extract (Extr actum Eucalypti Fluidum, 
U. S.) is given in the dose of 10 minims (0.65) to 2 drachms (8.0), the 
oil (Oleum Eucalypti, U. S. and B. P.) in the dose of 5 minims (0.35). 
The dose of eucalyptol is 5 grains (0.32) in capsule. 

Trochiscus Eucalypti Gummi and Uhguentum Eucalypti are official 
in the B. P., but are seldom used. 

EUDOXINE. 

Eudoxine is the bismuth salt of nosophen. (See Nosophen.) 
It occurs as an odorless, tasteless, insoluble, reddish-brown powder, 
containing less than 60 per cent, of iodine. Eudoxine is employed in 
medicine as an intestinal antiseptic and antifermentative. It is used 
in the diarrhoeas of children in the dose of \ to 5 grains (0.05-0.3), 
and given to adults for the same purpose in the dose of 5 to 20 
grains (0.3-1.3). The range of usefulness of this drug is much the 
same as bismuth in such cases, except that it is less astringent, but 
more antiseptic and alterative. Because of the latter influence it is 
indicated in subacute chronic catarrhal inflammations of the bowels. 

EUONYMUS. 

Euonymus, U. S., Euonymi Cortex, B. P., or Wahoo, is the bark 
of Eu ,on y in us Atropurpureus, a native plant of the United States. 
It contains an active principle, Euonymin, B. P. As a laxative its 
action is very slow and moderate, but it is thought to act particularly 
on the liver, and may be used when mild hepatic torpor is present. 

Administration. — The dose of the solid extinct ( Ext r a ctum Euonymi, 
U. S.. Extractum Euonymi Siccum) is 3 to 10 grains (0.15-0.65). Of 
euonymin the dose is J to 1 grain (0.03-0.05). 



EUPAT0RIUM—EUPHTHALM1N. 235 



EUPATORrUM. 

JEupatorium, U. S., Thoroughwort or Boneset, is the leaves of the 
Mwpatorium perfoliatum, an American plant which is very largely 
used as a simple bitter tonic and diaphoretic in household medicine. 
The drug is generally given in hot infusion in cases of arrested men- 
struation due to cold or in the chill of a remittent or intermittent fever, 
and also for anorexia and debility. Its taste is very disagreeable, and 
in the dose of a pint (500 cc.) of the cold infusion it has been used as 
an emetic. The fluid extract {JExtractum Eupatorii Fluiclum, U. S.) 
is given in the dose of 30 minims to 1 drachm (2.0-4.0). 



EUPHORBIA PILULIPERA. 

This herb is sometimes called Snake-weed or Cat's-hair, and is a 
native of Australia and the West Indies, where, like stramonium, it 
grows profusely as a weed by the wayside. 

Physiological Action. — In toxic doses the drug kills small ani- 
mals by failure of the respiration and circulation, these two vital 
functions being greatly affected by doses which exert no great influ- 
ence on the rest of the body. In full dose it may cause some gastric 
irritation. 

Therapeutics. — Euphorbia pilulifera is one of the latest remedies 
introduced into medicine for the relief and cure of asthma, in which 
disease the results obtained, after other remedies fail, are very extra- 
ordinary if the reports of those who have given it a thorough trial 
can be accepted without reserve. As yet we do not know the form 
of asthma which is most relieved by its use, and its employment is 
purely empirical. It has also been highly praised in the treatment 
of chronic bronchitis and emphysema. 

Administration. — Euphorbia pilulifera is host given in the form of 
the fluid extract in the dose of 30 minims to 1 drachm (2.0-4.0). The 
decoction is made by adding a " handful of stalks with the leaves on 
them to 2 quarts (2 litres) of boiling water, and boiling down to 1J 
quarts (1J litres)." Of this decoction the dose is a small wineglass- 
ful (64.0) three times a day. (See Asthma.) 

EUPHTHALMIN. 

Euphthalmin is a synthetic alkaloid used as an active mydriatic. 
It possesses an effect upon the general system very like that of atropine, 
but when first dropped into the eye may cause slight salivation through 
irritation of the secretory fibres of the chorda tympani, which it reaches 
after absorption. The pupil under its influence begins to dilate in from 
fifteen to twenty minutes after a few drops of a 2 to 10 per cent, solu- 
tion are instilled. The maximum dilatation is reached in about an 
hour, and disappears in about five to eight hours. Vinci states that 
the mydriasis is due to paralysis of the oculomotor nerve-endings, and 
that the sympathetic is not affected. 



236 DRUGS. 



EUROPHEN. 



Europken is the result of the action of iodine on isobutylortho- 
cresol in the presence of an alkali, and appears as a fine yellow powder, 
soluble in alcohol, ether, chloroform, and oils, but insoluble in water. 
It was introduced because it was hoped that it might prove a useful 
substitute for iodoform. One advantage claimed for it is that it 
parts with its iodine very slowly, and so is not apt to produce 
toxic symptoms as rapidly as does iodoform. For this very reason, 
however, it lacks the remedial power of the older drug, except in 
those instances in which a drying power is needed which will 
keep the wound pure by making it too dry to be favorable to the 
growth of germs. When such an action is desired, europhen pos- 
sesses the additional advantage of being five times as bulky as iodo- 
form. In the treatment of tuberculous growths europhen has already 
proved, itself very inferior to iodoform. Owing to its stability, it fails 
to part with its iodine except in the presence of moisture, and is use- 
less in dry skin diseases. It has been found useful in scrofuloderma 
ulcer of the legs, and lupus. Europhen may be employed externally 
in a salve of the strength of from 5 to 10 per cent., or with olive oil 
or lanolin. It can also be added to flexile collodion. The drug does 
not possess the odor of iodoform, but experience will probably prove 
it to be more irritating than the latter drug. The internal dose is 1 
to 3 grains (0.05-0.15) in cases of syphilis. Europhen is incompat- 
ible with metallic oxides and the preparations of mercury, and also 
with the starch and zinc paste largely used by dermatologists. 

EXALGINE. 

This substance is really methyl-acetanilid, and closely resembles 
acetanilid or antifebrin in its effects. It is given for the same pur- 
poses as is acetanilid and antipyrine — namely, for the relief of pain 
in locomotor ataxia and other nervous affections — but never as an 
antipyretic. When used, exalgine should be given night and morning 
as a rule, so that the doses shall not be near together. The beginning 
dose should be from 2 to 4 grains (0.1-0.2), and not more than 15 
grains (1.0) should be given in twenty -four hours. It is stated by those 
who have used the drug that fever contraindicates its employment. 

The following prescriptions will be found applicable : 

R.— Exalgini gr. xxx (2.0). 

Tincturae aurant. dulcis fsjij (8.0). — M. 

Ft. in sol. et adde 

Syr. aurantii f?ss (15.0). 

Aquae month, piperit q. s. ad f^iv (120.0). — M. 

S. — A tablespoonful night and morning. 

Or, 

Be.— Exalgini gr. xxx (2.0). 

Spt.frumenti f^ss (15.0).— M. 

Ft. in sol. et adde 

Syr. siinplicis f?j (30.0). 

Aquae dest q. s. ad fjiv (120.0).— M. 

S. — Tablespoonful night and morning. 



FLAXSEED— FORMIC ALDEHYDE. 237 

FLAXSEED. 

Flaxseed or Linseed (Linurn, U. S. and B. P.) is the seed of Linum 
usitatissimum, or flax from which linen is made ; it was official in the 
B. P. as Lini Semina. These seeds contain an oil and a mucilage, 
the first of which is largely used in the arts, and the second is some- 
times employed in medicine. The oil {Oleum Lini, U. S. and B. P.) 
is also used by physicians and pharmacists for various purposes. 

Therapeutics. — Flaxseed acts as a demulcent to inflamed mucous 
membranes, and is used largely in the treatment of acute cystitis, 
bronchitis, gastritis, nephritis, and similar states, in the form of flax- 
seed tea. This is prepared by mixing together 3 drachms (12.0) of 
flaxseed, not ground, 30 grains (2.0) of extract of liquorice, 10 ounces 
(320.0) of boiling water, and allowing the mixture to stand one to 
four hours in a warm place. If the mixture is boiled, the oil is set 
free and makes the dose disagreeable. This infusion may now be 
made more tasteful and useful by the addition of a little lemon-juice 
and sugar and by the placing of from 1 to 2 drachms (4.0-8.0) of 
gum arabic in the pitcher containing it. If the cough is excessive, 
a little paregoric may be added. Linseed oil is used sometimes as 
a laxative in the dose of 2 ounces (64.0), and is said to be of service 
when so given in the treatment of hemorrhoids. 

Flaxseed meal {Lini Farina) is employed universally when moist- 
ened as a useful poultice. 

Under the name of Carron oil an emulsion of lime-water and lin- 
seed oil, equal parts, is the standard application for limited or exten- 
sive burns. 

FORMIC ALDEHYDE (FORMALDEHYDE). 

Formaldehyde is useful to check excessive fetid sweating by virtue 
of its antiseptic effect and because it hardens and contracts the skin. 
The solution used may be made by diluting the 40 per cent, com- 
mercial solution with 4 to 6 parts of water, or using Euformol diluted 
or pure as a lotion. Euformol contains eucalyptus, gaultheria, menthol, 
boric acid, and formaldehyde, and is pleasanter to use than the crude 
preparation. Diluted in the proportion of 1 to 4 of water, it may be 
employed as a lotion to the entire body to check colliquative sweats. 

Formic aldehyde is a gaseous body difficult of application because 
of its physical characteristics, but nevertheless possessing very great 
power as a disinfectant or germicide. It is prepared by subjecting 
methyl alcohol to oxidation, and almost every instrument-maker has a 
device whereby this gas may be generated, and the room formerly occu- 
pied by a sick person thereby disinfected far more efficaciously than can 
be accomplished by burning sulphur. The doors and windows of the 
room should be tightly shut during the process of disinfection and for 
several hours after the formaldehyde generator is exhausted. As the 
gas is exceedingly irritating to the eyes and respiratory passages, no one 
should attempt to enter the room. After the disinfection is completed 
the room should be aired for some hours, or, if it must be used at once, 



238 DRUGS. 

it may be rendered capable of habitation by spraying a 20 per cent, 
solution of ammonia to neutralize the acid atmosphere. The great ad- 
vantage of formaldehyde for these purposes is the fact that it permeates 
every nook and cranny, and yet does no injury to colored fabrics, as 
does chlorine gas under similar circumstances. Such generators as 
have been named can be had for about four dollars. 

A solution of formic aldehyde in the strength of 40 per cent, has 
been widely used of late for disinfectant and antiseptic purposes. For 
all these purposes it is usually diluted still further by the addition of 
water. A 1 per cent, solution is usually quite active enough for sur- 
gical antisepsis, and is far less poisonous than is the bichloride of mer- 
cury. A similar percentage, or a little stronger, may be used to pre- 
serve pathological specimens, and it is stated that in the proportion of 
1 to 32,000 it will preserve milk for several days. Taken internally 
in small amounts, it does not possess any toxic properties. 

Concentrated undiluted formaldehyde solution may be used for the 
purpose of cauterizing syphilitic sores. 

The safety, efficiency, and cheapness of formaldehyde gas as a dis- 
infectant, and of the solution, render this agent a most valuable one. 
(See Disinfection.) 

Under the name of " Glutol " we have a compound of formaldehyde 
and gelatin used as an antiseptic powder, which, drying the surface of 
the wound or ulcer, seals it and renders it sterile. It is claimed to be 
a particularly efficient dressing for burns. 

GALLIC ACID. 

Acidum Grallicum (U. S. and B. P.) is usually prepared from 
tannic acid. It occurs in nearly colorless, long, needle-like crystals, 
which are soluble in 100 parts of cold water, 4^ parts of alcohol, and 
3 parts of boiling water. 

Physiological Action. — Gallic acid is an astringent, but not a coag- 
ulator of blood. Locally applied in bleeding, it is useless, but given 
internally in hemorrhages which cannot be acted upon by the direct 
local application of tannic acid, it is thought to be useful as a haemo- 
static because it contracts the blood-vessels. It is eliminated from the 
body by the kidneys as gallic acid. 

Therapeutics. — Gallic acid may be used with some success in licema- 
turia } haemoptysis, colliquative sweats, and in chronic bronchitis with 
profuse expectoration. 

Combined with opium, it is one of the best remedies in diabetes 
insipidus, and is even useful in diabetes mellitus. 

In albuminuria dependent upon a relaxed, atonic state of the kid- 
neys and in acute or chronic diarrhoea gallic acid may be used with 
advantage. In the form of the ointment it is useful in the treatment 
of 'psoriasis, and in the cure of ulcers and sores which are actively 
discharging. A very useful application to external hemorrhoids is 
equal parts of stramonium ointment and gallic acid. 

Administration. — Gallic acid is given in the dose of 2 to 40 grains 
(0.1—2.6) in pill or solution. It ought never to be used with any salt 



GA ULTHERIA— GELSEMIUM. 239 

of iron, as it is chemically incompatible. The preparation used locally 
is the Unguentum Acidi Gallici. 

Nut-gall. 

Nut-galls (Galla, U. S. and B. P.) are the small excrescences 
found upon the oak ( Quercus lusitanica) formed by the ova of the fly 
Cynips Gallon tinctorioe. Their sole value depends upon the tannic 
acid contained in them, and they are official in the form of the tinc- 
ture (Tinctura Gallce, U. #.), dose J to 2 fluidrachms (2.0-8.0), and 
the ointment {Unguentum G-allce, U. S. and B. P.). Unguentum 
Gallce cum Opio is official in the B. P., and is used as an astringent 
and sedative ointment. 

GAULTHERIA. 

Wintergreen, or Gaultheria procumbens, is an American ever- 
green containing a volatile oil. The oil possesses a peculiar, exceed- 
ingly penetrating odor and a warm aromatic taste. It is about 96 
per cent, salicylate of methyl. Salicylate of Methyl (Methyl Sali- 
cylatis, U. S.) is an artificial product made official in the last revision 
of the U. S. P. 

Physiological Action. — Owing to the large amount of salicylate of 
methyl contained in the oil, its physiological action is almost identical 
with that of salicylic acid. 

Therapeutics. — Aside from its use as a flavoring substance, oil of 
gaultheria may be used in place of the ordinary salicylates in all 
forms of rheumatism in which they are useful. This oil (Oleum 
Gaultheria?, U. S.) is best given in capsules or emulsion or dropped 
on a teaspoonful of sugar three times a day after meals. The dose 
may be as high as 100 minims (7.0) a day, but if 60 minims (4.0) 
three times a day do no good, pushing it further is practically use- 
less. Very few patients can take more than 30 minims a day without 
suffering from a disordered stomach. 

Lannois and Limousin, of Lyons, have highly recommended 
the application of this oil to acute and chronic rheumatic joiiits. 
The oil is placed on lint, and then the lint is wrapped around the part 
affected, evaporation being prevented by applying a gutta-percha cover- 
ing. They assert that this treatment gives rapid relief, although they 
admit that after it the skin may desquamate. 

The spirit of gaultheria (Spiritus G-aultherice, U. S.) is given in 
the dose of 10 to 20 minims (0.65-1.3). 

GELSEMIUM. 

Gelsemium, U. S., and Gelsemii Radix, B. P., or Yellow Jasmine, 
as used in medicine is the rhizome of the Gelsemium sempervirens, a 
climbing plant of the Southern United States. It contains an alka- 
loid, gelsemine, and gelseminic acid. 

Physiological Action. — Nervous, System. — Gelsemium paralyzes 



240 DRUGS. 

the spinal cord, particularly on its sensory side (?), although the motor 
side is certainly ultimately depressed. It does not influence the nerves 
or muscles except those of the head, on which it acts as a paralyzant, 
particularly affecting the motor fibres, 

Circulation. — Gelsemium is a depressant to the circulation, act- 
ing particularly on the heart. It paralyzes the vagus and lowers blood 
pressure. 

Respiration. — Gelsemium kills by paralyzing the respiratory cen- 
tres (Sanderson, Ringer, and Murrell). 

Temperature. — In overdose the drug lowers bodily heat very 
markedly. 

Eye. — Gelsemium is a mydriatic of considerable power, causing, 
when dropped into the eye, wide dilatation of the pupil, a result due 
to paralysis of the oculo-motor nerve peripherally. 

Therapeutics. — Gelsemium is used in headache and migraine depend- 
ing on nervous troubles or upon eye-strain. It is particularly useful 
in combination with cannabis indica. (See Cannabis Indica and 
Migraine.) 

In malarial fever it is said to be of great service, but this is doubt- 
ful. In the early stages of pneumonia and pleurisy it has been highly 
spoken of by Bartholow. 

Gelsemium has also been found of value in asthma, whooping 
cough, laryngismus stridulus, and nervous cough. In localized mus- 
cular spasm, such as seen in torticollis or ivry-nech, and in spasmodic 
dysmenorrhaea, it is of considerable service. It ought not to be used 
if the system is already depressed, but only in sthenic cases. 

When used as a mydriatic, Tweedy recommends gelsemine as equal 
to atropine in effect, but much more transient in its influence. He uses 
a solution of 8 grains of gelsemine to the ounce (0.5: 32.0) of water, 
instilled, drop by drop, into the eye every fifteen minutes for one 
hour, and then every half-hour for two hours. 

Poisoning. — The most prominent symptoms of gelsemium poison- 
ing are ptosis and dropping of the jaw. These are preceded by a 
sensation of languor, a desire to lie down, relaxation, and muscular 
weakness. Gelsemium is apt to cause temporary internal squint, 
owing to its paralyzant action on the sixth pair of cranial nerves. 
The pulse becomes rapid and feeble, the skin wet and cold, the face 
pinched and anxious, the voice is lost in aphonia, and death ensues 
from centric respirator) 7 failure and an almost simultaneous cardiac 
arrest. Sensation in man is impaired very late in the poisoning. 

The treatment of the poisoning consists in the use of cardiac stimu- 
lants, such as ammonia and digitalis, the application of external heat, 
and the employment of atropine and strychnine for the purpose of 
stimulating the respiratory centre. Emetics and the stomach-pump 
arc of course, to be employed if the patient is strong enough. 

Administration. — The fluid extract (Extractum Grelsemii Fluidum, 
U. S.) is given in the dose of 2 to 5 minims (0.16—0.35), and the 
tincture (Tinciura Grelsemii, U. S. and B. P.) -~> to 10 minims (0.03- 
0.65). In some parts of the United States physicians largely employ 
a very strong unofficial tincture of gelsemium, the dose of which is 



GENTIAN— GERANIUM— GINGER. 241 

1 to 2 minims. Gelsemine may be used in the dose of -^ of a grain 

(0.001). 

GENTIAN. 

Gentiana, U. S., is the root of the G-entiana lutea, or Yellow 
Gentian, a European plant. It contains gentianine and gentisic acid, 
and has a bitter taste. This drug is official in the B. P. as G-entianoe 
Radix. 

Therapeutics. — Gentian is one of the most efficacious bitter tonics 
that we possess. In the anorexia following acute diseases and in gout 
and malarial poisoning with dyspepsia it is of service. Combined with 
bicarbonate of sodium, it is of great service in the treatment of the 
subacute gastric and intestinal catarrh of children. 

Administration. — The compound tincture (Tinctura G-entianoe Com- 
posita, II. S. and B. P.) is given in the dose of 1 to 2 drachms (4.0- 
8.0), the fluid extract (JExtraetum Gentiance Fluidum, U. S.) in the 
dose of 30 minims to 1 drachm (2.0-4.0), and the solid extract JEx- 
traetum Gentiance, U. S. and B. P.) in the dose of 1 to 8 grains 
(0.05-0.40). Infusum Gentiance Gompositum, B. P., is given in the 
dose of 1 to 2 fluidounces (32.0-64.0). The compound tincture and 
compound infusion are composed of gentian, bitter orange-peel, and 
cardamoms. The following prescription is an excellent one for use in 
convalescence from prolonged fevers : 

R.— Acid, nitro-hydroclilor. dil. ' f^j vel f^ij (4.0-8.0). 

Tr. nncis vomicae fgj (4.0). 

Tr. cardaraomi comp f t fij (60.0). 

Tr. gentianse comp q. s. ad f^iv (120.0). — M. 

S. — Teaspoonful (4.0) in water after meals. 



GERANIUM. 

Geranium, U, S., is the rhizome of Geranium maculatum. It 
contains tannic and gallic acids, and is useful as an astringent in cases 
of serous diarrhoea. It is not the common red geranium seen in 
flower-gardens. 

In infantile diarrhoea geranium-root, boiled in milk in the propor- 
tion of one or two roots to the pint, will be found of great service 
and is. tasteless. The dose of the drug itself is 20 to 60 grains (1.3- 
4.0), and that of the fluid extract (JExtraetum Geranii Fluidum, 
U. S.) I to 1 fluidrachm (2.0-4.0). 



GINGER. 

Zingiber, TJ. S. and B. P., is the rhizome of Zingiber officinale, a 
plant of Hindostan, Jamaica, and other tropical countries. Black 
ginger is the dried rhizome with its bark, while white ginger has this 
covering removed. It contains a hot volatile oil and an aromatic 
resin, and is very largely used in domestic medicine as a carminative 

16 



242 DRUGS. 

and stomachic. In the treatment of menstrual cramps it is often 
given, and is particularly useful in those cramps due to suppres- 
sion from exposure to cold. Ginger is often combined with purgative 
medicines to stop griping and for its pleasant flavor. Of itself it is 
decidedly constipating, and when used in diarrhoea mixtures is of value 
other than as a flavoring addition to the prescription. 

Administration. — The fluid extract (Extr actum Zingiberis Fluidum, 
U. S.) is given in the dose of 10 to 30 minims (0.65-2.0), well diluted; 
the tincture (Tinctura Zingiberis, U. S. and B. P.), dose 20 minims 
to 2 drachms (1.3-8.0): the syrup (Syrupus Zingiberis, U. 8. and 
B. P.), dose 30 minims to 2 drachms (2.0-8.0) ; the oleoresin {Oleo- 
resina Zingiberis, U. #.), dose J to 1 minim (0.03-0.05), well diluted 
or in pill ; and the troches (Trochisci Zingiberis, U. S.) used as stimu- 
lants to salivary secretion. 

GLANDULAR TREATMENT. 

Within the past ten years physiological investigations have indi- 
cated that several glands in the body not only secrete substances in 
the body-cavities, but also pour out into the blood- or lymph-vessels 
ferments or substances which perform definite physiological functions 
in the system. Disease of these glands perverts these functions, and 
secondary disorders follow. Acting upon the discoveries just named, 
some persons have attempted to show that nearly all of the organs of 
the body, be they glands or not, possess these functions, until they 
have reached a reductio ad absurdum. On the other hand, some of 
the glands are now used, when derived from the lower animals, for 
definite therapeutic purposes, such as the thyroid gland and the supra- 
renal bodies, for example. The use of the glands will be found dis- 
cussed under their oavh names, but unimportant glands in therapy, or 
those in regard to which doubt exists, are included under the general 
heading here given. 

The employment of testicular juice, or the dried gland itself, has 
been practically abandoned, but the juice of the ovary seems to possess 
considerable power. It has been used to combat the symptoms follow- 
ing double oophorectomy and those common to the menopause, and also 
tor aphrodisiac purposes. On the ground that chlorosis is due to a 
faulty internal secretion of the ovary, it has been given in this condi- 
tion with asserted good results, and also in osteomalacia, neurasthenia, 
and hysteria. The dose is from 2 to 4 grains (0.10-0.20) a day. (See 
Ovarian Extract and Mammary Gland.) 

The use of cerebral and spinal extracts has proved futile, as has 
also the use of bone-marrow, in pernicious ana>mia. The pancreas 
has boon used in pancreatic diabetes, but its value is in doubt. The 
liver lias l)oon given in the dose of 3 ounces (90.0) of fresh gland a 
day to combat the delirium of cirrhosis, with asserted good results 
(Carnot), and has boon thought to do good in alcoholic cirrhosis with 
icterus, in that the hemorrhages were arrested, the delirium ceased, 
and the patient generally improved. The same treatment has been 
tried in diabetes. It is difficult to see how it can be of benefit. 



GLYCERIN. 243 

While glandular therapeutics gives promise of aiding us greatly in 
the treatment of disease, and while for this reason the cautious phy- 
sician should not oppose resort to the use of glandular extracts, he 
should, nevertheless, always study the physiological function of the 
gland to be employed in order that he may reach a clear idea of its 
remedial possibilities. The extraordinary effects of some glands do 
not prove that all animal extracts are of value, nor does the failure 
of others indicate that all are useless. 

GLYCERIN. 

Grlycerinum, U. S. and B. P., is a liquid obtained by the decom- 
position and distillation of fats. It possesses great power in absorb- 
ing water and of dissolving many substances. Even if pure it irri- 
tates the skin of susceptible persons when applied locally by its absorp- 
tion of water, and often causes a slight rash. 

Physiological Action. — Injected into the circulation in large amounts, 
glycerin causes convulsions, which are due to its hygroscopic power. 

According to the clinical researches of Pavy, glycerin increases 
the polyuria of diabetes almost one-half, and for this reason he thinks 
it is not to be employed in this class of cases as a substitute for 
sugar. Other clinicians, however, disagree with him and use it con- 
stantly for this purpose with asserted advantage. 

Therapeutics. — Glycerin may be employed as a sweetening agent 
in the food of diabetics and in cases wdiere sugar cannot be used. It 
has also been given as a laxative in 1- or 2-drachm (4.0-8.0) doses by 
the mouth, and in enema — 1 to 4 drachms (4.0-16.0) with or without 
equal parts of water. In some cases it may be used in suppository 
in the official Suppositoria Glycerini, U. S. and B. P. This latter 
method is very successful in chronic constipation. Its continued use 
by suppository may, however, result in rectal irritation. 

As an antiseptic it is used for preserving specimens and for keep- 
ing alkaloids in solution for hypodermic use. 

In acute, coryza, applied by a spray or brush to the nostrils, it is 
sometimes of service ; for this purpose it should be diluted four or 
five times with water. If used on the skin, it should be diluted one- 
half with water. In cases of impacted cerumen in the external audi- 
tory canal glycerin is often of service in softening the mass. 

The uses of glycerin, other than those mentioned, are many. In 
the proportion of equal parts of glycerin and water it makes a very 
useful mouth-wash for the sore and dry mouth of typhoid fever and for 
the removal of sordes. The same w 7 ash, with lemon-juice added to it, 
is very agreeable and will relieve the dry, glazed tongue of advanced 
phthisis. 

Owing to the fact that glycerin is hygroscopic, it may be used as a 
depletant on a pledget of cotton in congestion of the uterine cervix, the 
tampon being renewed daily. (See Boric Acid and Boroglyceride.) 

For the prevention of bed-sores Ringer recommends the daily wash- 
ing and rubbing of the part likely to be affected, followed by the 



244 DRUGS. 

application of glycerin and water, with a draw-sheet placed smoothly 
against the patient to protect the bedding. 

Glycerin and whiskey is a favorite household remedy for colds and 
coughs, but is not very useful. Glycerite of starch {Glycerinum 
Amyli, XI. S. and B. P.) is used as a protective over superficial irri- 
tations of the skin. Glycerite of yolk of egg (Glyceritum Vitelli, 
U. S.) is used in making emulsions. 

A very useful ointment for the application of medicinal substances 
to the skin may be made by mixing constantly in the presence of heat 
1 part of potato starch and 15 parts of pure glycerin. The result is 
a clear, transparent, jelly-like substance which does not decompose, 
and has the advantage of holding the medicament which it carries in 
solution rather than by mechanical suspension. 

The B. P. preparations of glycerin are as follows : Glycerinum 
Acidi Carbolici, Grlycerinum Acidi Tannici, Glycerinum Aluminis, 
Glycerinum Acidi Borici, Glycerinum Plumbi Subacetatis, Glycerinum 
Tragacanthce, Glycerinum Boracis, Glycerinum Pepsini, Glycerinum 
Amyli, and Unguentum Glycerini Plumbi Subacetatis. 

GOLD. 

Gold itself is not official in the U. S. Pharmacopoeia, but has been 
recommended very highly by Bartholow in chronic Bright? s disease in 
the form of the chloride of gold and sodium {Auri el Sodii Chloridum, 
U. S.). The dose of this substance is ^ to -^ of a grain (0.003- 
0.006) once, twice, or thrice a day. The author has not found it of 
much value. Gold has also been strongly recommended for indiges- 
tion with epigastric pain after eating when looseness of the bowels is 
present, and it is said to act as a powerful sexual stimulant and to be 
of service in impotence dependent upon inability to obtain an erection 
or when there is deficient glandular action. It has also been used in 
excessive nocturnal emissions in masturbators, with asserted great 
success. In overdoses the drug causes gastro-enteritis. Magruder has 
recommended chloride of gold and sodium in the treatment of pertussis. 



GRINDELIA ROBUSTA. 

Grindelia, U. S., is an American plant (Grindelia robusta) con- 
taining a resin, a volatile oil, and an alkaloid. 

Physiological Action. — Upon the lower animals and man this drug 
is not very powerful in its action, but may cause, in large doses, 
paralysis of the peripheral sensory nerves, the sensory centres in the 
spinal cord, and finally the motor centres and nerve-trunks. It slows 
the heart by stimulating the vagi, and raises blood-pressure by stimu- 
lating the vasomotor centre. 

Therapeutics. — Grindelia robusta is an exceedingly useful remedy 
in some cases of asthma and in bronchitis in its later stages. It may 
be given in the dose of 20 to P>0 minims (1.3-4.0) of the fluid extract 
(JExtractum Grindelia Fluidum, IL >S'.), or by inhaling the fumes of 
burning grindelia-leaves, which have been previously soaked in a solu- 



G UAIAC— GUAIACOL. 245 

tion of nitre, dried, and burned on a plate or rolled into a cigarette and 
smoked. In chronic cystitis it stimulates the bladder and is of great 
service. By diluting it 1 to 10 with water it forms one of the best 
lotions that we have for the relief of the dermatitis produced by poison 
ivy or Rims Toxicodendron. 

Administration. — The only preparation which is official is the fluid 
extract (Extractum Grindelice Fluidum, TJ. S.), dose 20 to 60 minims 
(1,3-4.0). 

GUAIAC. 

Lignum Vitae, or Guaiacum officinale, a West Indian tree, is used 
in medicine in two forms — namely, as guaiac wood (Guaiaci Lignum, 
TJ. S. and B. P.), which is in raspings and enters into the compound 
syrup of sarsaparilla, and guaiac resin (Guaiaci Resina, TJ. S. and 
B. P.), or guaiac, which is soluble in alcohol, ether, and chloroform, 
but is insoluble in water. 

Therapeutics. — Guaiac has been largely used in syphilis, but is 
now rarely, if ever, so employed. Given in acute tonsillitis in the 
dose of 30 grains in an emulsion made by the use of white of egg, it 
will often abort the disease. In rheumatism it has been largely used. 
The ammoniated tincture of guaiac is sometimes employed in the 
treatment of sore throat, particularly if it be rheumatic in type, but 
is a disagreeable preparation to take into the mouth, and the sali- 
cylates may always be used in its place. 

Administration. — The tincture (Tinctura Guaiaci, TJ. S.) is given 
in the dose of 5 to 60 minims (0.35-4.0), and the ammoniated tincture 
(Tinctura Guaiaci Ammoniata, TJ. S. and B. P.) is used in the same 
dose, preferably in milk. Mistura Guaiaci, B. P., is given in the 
dose of 1 to 2 fluidounces (30.0-60.0). Trochiscus Guaiaci Resince 
are official in the B. P. 



GUAIACOL. 

Guaiacol is a liquid constituting from 60 to 90 per cent, of creo- 
sote. It is obtained by the distillation of beechwood creosote, fol- 
lowed by a complicated process which it is not necessary to describe. 
In other cases guaiacol is obtained from beechwood creosote by pre- 
cipitation with barium hydrate. Much of the "absolute guaiacol" 
of commerce is impure. Chemically pure guaiacol, obtained by the 
process last named, is a light-colored fluid of an agreeable odor and 
soluble in water in the proportion of 1 to 85 (Helbing). It is easily 
soluble in alcohol and ether. 

Therapeutics. — Guaiacol has been largely used by some practition- 
ers, chiefly in Europe, in the treatment of tuberculosis as a substitute 
for creosote, because it is the principal ingredient of that drug. (See 
Creosote.) It was thought by Guttmann, Sommerbrodt, and others 
that the good effect of creosote was due to its destructive action on 
the bacillus, or that it so improved digestion as to increase the resist- 



246 DRUGS. 

ance of the patient to the spread of the disease. Recently, Hoelscher 
and Seifert have asserted that guaiacol and creosote produce their 
good effects by forming compounds with the toxines or poisonous 
albuminoids formed by the bacilli, which are then eliminated from 
the body. The same rules govern the use of guaiacol as govern the 
employment of creosote. It is best given with brandy, wine, or other 
alcoholic drink, or in capsules with cod-liver or sweet oil. 5 or 10 
minims (0.35-0.65) of guaiacol may be added to a pitcher of hot water 
and the vapor inhaled three or four times a day in cases of subacute 
and chronic bronchitis. The dose by the stomach is 5 to 20 minims 
(0.35-1.5). In acute follicular tonsillitis pure guaiacol may be care- 
fully painted over the tonsils with great advantage. 

Clinical observations prove conclusively that guaiacol possesses 
powerful antipyretic influences. As pointed out by Sciolla in 1893, 
guaiacol when painted on the skin of a febrile patient causes a 
pronounced fall of temperature, which begins soon after the applica- 
tion is made, but is not fully accomplished for from two to three 
hours. The application may be made to the skin of the abdomen, 
thighs, or chest, about 30 to 40 minims (2.0-2.6) being used with a 
brush. When a full effect is required, it is well to place an imper- 
meable dressing over the part painted to prevent evaporation and aid 
absorption. These applications may be resorted to as often as is 
necessary for the reduction of the fever, and, although the fall of 
temperature is sometimes very rapid and very great — as much as 
7° F. in two hours — DaCosta has never seen serious nervous or car- 
diac symptoms produced, but other observers have noted such unto- 
ward results. The temperature is very apt to speedily rise after the 
reduction, and this rise is often preceded by a chill. These appli- 
cations cannot supplant the cold bath, although they undoubtedly 
do reduce the temperature. The true sphere of usefulness to be 
assigned to guaiacol as an antipyretic seems to be that of a less 
valuable therapeutic measure than the bath, and one equally power- 
ful and about as dangerous as are the antipyretic drugs of coal-tar 
derivation. 

When used externally in the fever of tuberculosis its action is very 
satisfactory, but the presence of cavities contraindicates its use, it is 
said. 

The studies of Stolzenberg show that if frequently and constantly 
used guaiacol produces in febrile patients a tendency toward depression. 
Thayer finds that great sweating and depression generally follow its 
external use in fevers. 

Probably future reports will develop the fact that in cases of renal 
irritation guaiacol will prove harmful. 

Guaiacol has been used by painting it on the affected part in the 
treatment of superficial neuralgias, and in deep-seated nerve-pains, as 
in sciatica, it has been given hypodermically in the dose of 2 minims 
in 10 minims of spirit of chloroform deeply into the neighborhood of 
l lie painful nerve. 

If guaiacol is placed upon the skin by means of a small compress, 
which has been wet with it and bound tightly to the part, local anaes- 



GUA1AC0L CARBONATE— HMMATOXYLON. 247 

thesia is rapidly developed, but if it is left in place too long, it may 
be absorbed in sufficient amount to cause depression or a fall of tem- 
perature. 

Belfield highly recommends painting the scrotum with guaiacol 15 
minims (1.0) and glycerin 45 minims (3.0) for orchitis, or an ointment 
of guaiacol 1 drachm (4.0) to 4 drachms (16.0) of lanolin may be 
rubbed into the scrotum and applied on lint. This should be applied 
every other day. 

A serious objection to the external use of guaiacol is its disagree- 
able odor. 



GUAIACOL CARBONATE. 

Carbonate of guaiacol is a white, crystalline powder, consisting of 91 
per cent, of pure guaiacol and 9 per cent, of carbonic acid. This 
powder is insoluble in water, neutral in reaction, and is said to be with- 
out any irritating effect on the stomach. Taken by the healthy indi- 
vidual, it is decomposed into guaiacol and carbonic acid in the bowel, 
but not in the stomach, and it is used for this reason, as salol is, as an 
intestinal antiseptic in the various forms of fermentative diarrhoea and 
typhoid fever. The drug is said to be slowly absorbed, but after ab- 
sorption is rapidly eliminated. Its therapeutic applications in tuber- 
culosis are practically identical with those of pure guaiacol, save that 
it is more readily borne by the stomach than the latter drug. Guaiacol 
carbonate may be given in capsule or pill, or it may be given in dry 
powder on the tongue in the dose of 2 to 10 grains (0.10-0.65). 
Usually in typhoid fever the dose is about 2 grains (0.10) every three 
hours, and in tuberculosis of the lungs 5 grains (0.35) three times a 
day. 

HEMATOXYLIN. 

Hcematoxylorty U. S., Hamiatoxyli Lignum, B. P., or Logwood, is 
the heart-wood of Hcematoxylon campechianum, a tree of the Amer- 
ican tropics. It contains an active principle, hematoxylin. 

Therapeutics. — Haematoxylon is a mild astringent, very useful in 
serous diarrhoeas and in the diarrhoeas of young children, as children 
do not dislike it, owing to its agreeable taste. (See article on Diar- 
rhoea.). As it colors the stools and urine red, the nurse should be 
warned lest she be alarmed at the sight of what looks like blood on 
the diaper after the drug is given to infants. If the urine is alka- 
line, the color may be violet or red. In leucorrhoea its internal use is 
of service. The extract (Extr actum Hcematoxyli, U. jS.) is given in 
the dose of 8 to 30 grains (0.6-2.0), and Decoctum Hcematoxyli, B. P., 
in the dose of 1 to 2 fluidounces (30.0-60.0). An unofficial fluid 
extract is often to be found in the shops. The dose of this is J to 2 
fluidrachms (2.0-8.0). (See article on Diarrhoea.) 



248 DEUGS. 



HAMAMELIS. 

Hamamelis, U. S., Hamamelidis Cortex and Hamamelidis Folia. 
B. P.. Witch-hazel, or Hamamelis Virginia na, is a plant of the United 
States, devoid of any true active principle, but possessing extraordinary 
remedial power. 

Therapeutics. — Hamamelis is to be employed in relaxed sore throat 
resulting in congestion and hypeneinia upon exposure or where mild 
catarrhal states are present. Similarly, we employ it in an atomizer, 
after attacks of acute coryza, to tone up the nasal mucous membrane. 
The strength of the solution should be 20 to 60 minims (1.3—4.0) of the 
distilled extract to the ounce (30.0) of water. Hamamelis when taken 
internally is often very successful in the treatment of uterine oozing 
from small blood-vessels, seems to do good even in hamatemesis 
and haemoptysis, and will sometimes arrest hematuria when all other 
remedies fail. Applied by means of cloths to recent leg ulcers, it acts 
very thoroughly and rapidly relieves the angry-looking skin surrounding 
the ulcer. The limb should be elevated and at rest while the treat- 
ment is pursued. In bleeding from the bladder it may be injected into 
this viscus daily in the form of the distilled fluid extract. Taken 
internally and applied locally, it is of value in the treatment of bleed- 
ing and the so-called blind piles. (See Hemorrhoids.) 

Administration. — The one official preparation in the U. S. P. is the 
fluid extract (Extractum Hamamelidis Fluidum, U. S. ; Liquidum, 
B. P.). dose 5 to 20 minims (0.35-1.30). The dose of the distilled 
extract, which is not official and is a perfectly clear fluid, is from 30 
minims to 1 drachm (2.0-4.0), and this is much the best preparation 
for internal and external use. Unfortunately, this preparation of the 
drug varies very much both in odor and efficacy. Some of the pro- 
prietarv preparations of witch-hazel are more active than those ordi- 
narily dispensed in the drug-store. This is due to greater care in 
their preparation, and to the fact that they are sold in original 
packages without exposure to the air. The B. P. recognizes a solu- 
tion. Liquor Hamamelidis, Tinctura Hamamelidis, and Unguentum 
Hamamelidis. 

HEROIN. 

Heroin is the diacetyl-acid-ester of morphine, and is a white crys- 
talline powder Avithout odor and of a slightly bitter taste. It is used 
in medicine for the purpose of controlling excessive cough. Unlike 
morphine, its effect on the respiratory centre is stimulant rather than 
depressant when it is given in medicinal doses. Under its influence 
the respirations are usually slightly slowed and deepened. The dose 
is ,1, to !, ,L r r;iin (0.005-0.01) three times a day. Large doses do not 
act as well :i- Bmall ones a- a rule. It is -aid to he of value in uroemtC 
dyspnoea. The fact that it does not stupefy the patient nor produce 
constipation is strongly in its favor. As heroin is insoluble, the 
hydrochloride of heroin is the preparation used for watery solutions; 
or heroin itself may he dissolved in water to which a little acetic acid 



HOFFMANN'S ANODYNE— HOLOCAINE. 249 

lias been added. It may also be given in pill or powder with white 
sugar. 

HOFFMANN'S ANODYNE. 

Spiritus ^Etheris Compositus, IT. S. and B. P., consists of alco- 
hol, ether, and the heavy oil of wine. The writer has experimentally 
studied very thoroughly the action of the last-named ingredient, and 
finds : 

First. That the belief in heavy oil of wine being the quieting 
agent in Hoffmann's anodyne is fallacious. 

Second. The calmative effects of this mixture depend largely on 
the ether, rather than on the oil. 

Third. It would seem probable that in Hoffmann's anodyne we 
possess an agent in which there are linked together three drugs of 
undoubted power, each one of which successively substitutes the 
other, stimulating the system in the order here named — viz. ether, 
alcohol, and the heavy oil of wine. 

Therapeutics. — Hoffmann's anodyne is the best carminative that 
we possess for general use, and is one of the best remedies for singultus 
or hiccough. This effect is accomplished by the alcohol and ether 
acting as irritants or stimulants to the stomach and intestine, so that 
free peristalsis results. In angina pectoris this drug is often the best 
remedy we have during the attack. In the cardiac palpitation of 
tobacco-heart or in that arising from indigestion and in the nausea and 
depression seen after excessive smoking it is also very useful. 

Hoffmann's anodyne should always be given in capsules or in cold 
water, preferably ice-cold, in order to prevent too rapid volatilization 
of the ether and consequent difficulty in swallowing the liquid. 

The dose is 1 to 2 drachms (4.0-8.0) to an adult. The vapor of 
the ether is so irritating that the drug is difficult of administration to 
very young children. 

HOLOCAINE. 

Holocaine is a synthetic substance allied to phenacetine, which is 
almost insoluble in cold water, and which is therefore commonly em- 
ployed in the form of the soluble hydrochloride. This salt is a white 
crystalline body, which is very stable when brought in contact with 
many agents, but is readily decomposed by alkalies. Solutions of this 
preparation possess distinct antiseptic power, and therefore do not re- 
quire boiling in order that they may be sterile. As the drug when 
in solution gradually loses its anaesthetic power, it should be freshly 
dissolved each time it is needed. 

Holocaine is used as a local anaesthetic for the eye in place of cocaine, 
usually in the strength of 1 per cent. Its effects begin in about fifteen 
seconds to one minute, and last about five to fifteen minutes. It does 
not dilate the pupil as does cocaine, nor does it affect intraocular ten- 
sion or roughen the corneal epithelium. Holocaine has not supplanted 
cocaine, but, for the reason just given, is useful in cases requiring 
anaesthesia and yet at the same time suffering from keratitis or iritis. 



250 DRUGS. 

It does not cause primary ischemia or secondary hyperemia of the 
mucous membrane. 



HOMATROPINE. 

Homatropine is an artificial alkaloid obtained by prolonged and 
gentle beating of a solution of equivalent quantities of tropine 1 and 
toluic acid in h} T drochloric acid. The hydrobromate of homatropine 
(JSomatropincB Hydrobromidum, B. P.) is a crystallizable salt of hom- 
atropine, soluble in 10 parts of distilled water. The B. P. recognizes 
discs of homatropine (Lamellce Homatropince). 

Hydrobromate of homatropine, properly applied by frequent instil- 
lations, is a reliable mydriatic for the correction of anomalies of refrac- 
tion in healthy eyes. Experience is not at hand to determine its value 
for this purpose in eyes affected with retinal-choroidal disturbance. 
Atropine and hyoscyamine are preferred under such circumstances, 
for the obvious reason that their prolonged action is desirable as a 
method of treatment. The danger of systemic disturbance from hom- 
atropine is far removed, even when repeated instillations have been 
made, and its temporary action upon the pulse causes no inconvenience 
to the patient. Slight hyperemia of the conjunctiva almost invaria- 
bly follows its use, but true conjunctivitis, if it occurs at all, must be 
excessively rare. According to the studies of Dr. de Schweinitz and 
the writer, the drug has a physiological action closely allied to that of 
atropine, from which it is derived. Homatropine mydriasis generally 
lasts from thirty-six to forty-eight hours, that of hyoscyamine eight 
to nine days, and that of atropine ten to twelve days. For the pro- 
duction of ordinary mydriasis the drug should be used in solution of 
the strength of 4 grains (0.20) to the ounce (30.0) of distilled water, 
which is to be dropped into the eye every five or ten minutes. As 
the drug is expensive, only a few drachms of the solution of the 
strength named should be ordered for a patient. 



HONEY. 

Honey, or Mel, U. S., is the saccharine fluid deposited in combs 
by the honey-bee, or Apis mellifica. It is used in medicine to cover 
the taste of disagreeable medicines. When it is abstracted from a 
particular variety of flowers, it frequently has the odor of the flower, 
and when taken internally may even produce the physiological or poi- 
sonous effects of the plant from which it is gathered. This accident 
occurs commonly in those parts of the country where the bees have 
bad access to mountain laurel and similar plants. 

Therapeutics. — Honey mixed with water is used as a vehicle in 
gargles and to relieve cough and dryness of the mouth mid fauces. 
When used as a gargle it very distinctly increases the secretion of the 
mucous membrane, and so relieves the congestion. 

1 Tropine is ;i product obtained by splitting up atropine into tropine and tropic 
add. 



HOPE'S CAMPHOR MIXTURE. 251 

Under the name of Oxymel the B. P. recognizes a mixture of 8 
parts of honey, 1 of acetic acid, and 1 of water. This is generally used 
as a vehicle for more active remedies in gargles or even for expectorant 
mixtures. Melted and strained honey, to which a small proportion of 
glycerin is added, is known as Mel Despumatum, TJ. S., and Mel De- 
pur atum, B. P. There are also a honey of roses {Mel Bosce, TJ. S.) 
and a confection {Confectio Bosoz, TJ. $.), used as vehicles for other 
drugs. Mel Boracis, B. P., is used for the same purposes and for 
stomatitis. 

The objection to the use of honey in vehicles for active medicines 
is the fact that it is apt to disorder the stomach. 

HOPE'S CAMPHOR MIXTURE. 

This is a mixture originally made with nitrous acid, but largely 
used at present with nitric acid, owing to the fact that nitrous acid 
is changed into nitric acid when water is added to it. The nitrous 
acid is, however, more efficacious than nitric acid in the serous or 
choleraic diarrhoeas which it is used to combat. The formula is as 
follows : 

R. — Acidi nitrosi f^j (4.0). 

Aquse camphorse f^viij (256.0). 

Et adde 

Tinct. opii . . . gtt. xl (2.65).—M. 

S. — One-fourth of this in water every three or four hours. 



HOPS. 

. Humulus, TJ. S., is the strobiles of ordinary hops, or Humulus 
Lupulus. These contain a liquid volatile alkaloid, lupuline, and a bitter 
principle, lupulinic acid. Hops are known under the name of Lupulus 
in the B. P. Much confusion has arisen in regard to the preparations 
of this drug, partly because Humulus is the official name in the 
TJ. S. P. and Lupulus in the B. P. This confusion has been increased 
by the fact that the alkaloid of hops is called lupuline, while the 
powder which is found on the strobiles is called lupulin. Those 
preparations in the TJ. S. P. having the Avord "humulus" in their 
name are made from the hops themselves, those w T ith "lupulin" in 
their name from the powder of the strobiles. 

Therapeutics. — Hops are used as antispasmodics and nervous seda- 
tives in cases of hysteria and nervousness. In priapism, vesical irrita- 
bility, and renal irritation they are of service. Even in delirium 
tremens they seem to be of value. For local application a hop poul- 
tice may be made by placing the powdered strobiles in the mass, and 
employed in this way they are a favorite home remedy for local pain- 
ful inflammations. Hops have been used in the form of a hop pillow 
in nervous insomnia, but the soporific influence is largely imaginary 
or depends on the fumes of the alcohol with which the pillow is 
moistened. 

Administration. — The tincture (Tinctura Humuli,TJ. S.) is given 



252 DRUGS. 

in the dose of J to 3 ounces (15.0-90.0). Lupulin (Lupulinum, U. S. 
and B. P.), which is the powder found on the strobiles of hops, is 
given in the dose of 2 to 5 grains (0.1-0.35) or more ; the oleoresin 
of lupulin (Oleoresi)ia Lupulini, U. S.) is given in dose of 10 to 40 
minims (0.65-2.65) in capsules : and the fluid extract (JExtr actum 
Lupulini Fluidum, U. S.), in the dose of 30 to 120 minims (2.0-8.0). 
The preparations of the B. P. are the infusion (Infusum Lupuli), dose 
1 to 2 fluidounces (30.0-60.0); and the tincture (Tinctura Lupuli), 
dose J to 2 nuidrachms (2.0-8.0). 

HYDRASTIS. 

Hydrastis, U. S., or Hydrastis Rhizoma, B. P., is the rhizome 
of the Hydrastis Canadensis, sometimes called " Golden Seal," con- 
taining two alkaloids, known as hjdrastine and berberine, and, per- 
haps, xanthopuccin. 

Physiological Action. — When given to one of the lower animals in 
poisonous doses hydrastis may cause spinal convulsions followed by 
paralysis, according to the quantity of berberine or hydrastine present. 
The latter is more convulsive in its effects than the former. Upon 
the circulation hydrastine, when injected into the jugular vein, causes 
a primary fall of arterial pressure, succeeded by a decided rise, and 
the studies of Cerna have proved that it is an active poison. When 
given to man in medicinal amounts its effect on vital functions is very 
slight indeed. 

Therapeutics. — Hydrastis is of service in chronic g astro-intestinal 
catarrh, particularly that following the abuse of alcohol, and may be 
used as a stomachic and tonic after malarial fever and similar depress- 
ing diseases. "Wherever membranes exist in a condition of lowered 
tone this drug is indicated. Thus in catarrhal jaundice of a subacute 
type, in uterine catarrh, in leucorrhoea dependent upon a relaxed state 
of the vagina, and in chronic nasal inflammations and irritations it 
will be found useful. 

Tincture of hydrastis is said to possess a distinct antimalarial 
influence, but this is doubtful. 

One of the best remedial measures that we have in the later stages 
of gonorrhoea, when the acute period has passed, is the local and 
internal use of hydrastis. If it is used as an injection, 5 grains (0.3) 
of the commercial hydrastine to each ounce (30.0) of water should be 
employed twice a day. Belfield has highly recommended the follow- 
ing formula for use in this disease prior to the tenth day : 

I£. — Ilvdrastin. hydrochloratis gr. v (0.3). 

Protargol. gr. v. (0.3). 

Glycerin .' f.jsa (0.2). 

A(,u :i . destillat q. s. ad i'z] (30.0).— M. 

S. — Precede with a hot-Water injection and use four to six times daily, telling the 
patient to retain it five to ten minutes each time. 

The following infusion will be found of service in vaginal gonorrhoea 
and leucorrhoea; Take 1 drachm of the powdered root and add it to 8 



HYDROCHLORIC ACID. 253 

ounces of boiling water ; J to 1 drachm of the fluid extract may also 
be added to a pint of water and used as a wash. 

Administration. — The fluid extract (JExtractum Hydrastis Fluidum, 
TJ. S. ; Liquidum, B. P.) may be given in the dose of 5 to 30 minims 
(0.30-2.0), while the dose of the tincture (Tinctura Hydrastis, TJ. S. 
and B. P.) is from 30 minims to 2 drachms (2.0-8.0). The Gly- 
ceritum Hydrastis, TJ. S., is used as a healing application to mucous 
membranes. 

Much doubt exists as to the dose of hydrastine. This arises from 
the fact that two forms of it are sold. The most commonly seen is 
a dark-brown mass which is very impure, and contains berberine and 
other substances. Its dose is 3 to 10 grains (0.15-0.65). The pure 
hydrastine, as made by Merck, is given in the dose of \ to \ grain 
(6.016-0.03). Hydrastinine hydrochlorate, an artificial alkaloid of 
hydrastine, has become official in the TJ. S. P. of 1890. 



HYDROBROMIC ACID. 

(See Bromides.) 

HYDROCHLORIC ACID. 

Aeidum Hydrochloricurn ( TJ. S. and B. P.) is a clear, colorless 
liquid, possessing an acid odor and taste, devoid of astringency, but 
in concentrated form decidedly caustic. It should be kept in dark- 
colored bottles. In the strength of two-tenths of 1 per cent, it is 
normally present in the gastric juice, and aids the pepsin in the con- 
version of proteids into peptones and in the formation of pepsin from 
pepsinogen. 

Therapeutics. — Hydrochloric acid is indicated only in certain forms 
of indigestion. With new methods of studying gastric secretions we 
have learned that it is of value in those cases in which the gastric 
secretion of HC1 is deficient. Thus it is given to aid digestion dur- 
ing and after fevers, when this acid is apt to be absent from the gastric 
juice, particularly in typhoid fever. In cases of gastric cancer, when 
this acid is usually absent from the gastric secretion, and in the sick 
stomach following an alcoholic debauch, it is of great service. In 
some cases of chronic gastric catarrh with dilatation, in which there is 
atrophy of the gastric tubules, it should be used freely. The dose of 
the dilute acid (Aeidum Hydrochloricurn Dilutum, TJ. S. and B. P.) is 
5 to 20 minims (0.36-1.3). 

A useful prescription in such cases is the one that follows : 

R .—Acid, hydrochloric, dil ".,'..'■. fgij (8.0). 

Pepsin, cordial. . . . fjj (30.0). 

Tinct. gentian, corap q. s. ad f^iv (120.0). — M. 

S. — Dessertspoonful (8.0) in a little water with meals. 

This acid is combined with nitric acid to form dilute nitro-hydro- 



254 



DRUGS. 



chloric acid (Acidum Nitro-hydrocliloricum Dilutum, U. S. and B. P.), 
the dose of which is 10 to 30 minims (0.65-2.0); also the pure acid 
{Acidum Nitro-hydrochloricum, TJ. S.), dose 1 to 5 minims (0.05-0.35). 
Hydrochloric acid causes, when taken in poisonous doses, violent 
c/astro-enteritis and corrosion of the gastric walls, and its action should 
be combated by alkalies, soap, oils, and white of egg, and the use of 
opium to relieve pain and irritation. 

HYDROCYANIC ACID. 

Hydrocyanic or Prussic Acid is a transparent, colorless, very volatile 
liquid, giving rise to vertigo when inhaled in minute amounts and 
capable of producing death if the fumes be concentrated. If the 
bottle containing the pure drug be opened, it should be done where 
there is sufficient draught between windows to prevent any contamina- 
tion of the atmosphere of the room by the acid. 

Pure hydrocyanic acid is never used in medicine ; the form employed 
is the dilute acid (Acidum Hydrocyanicum Dilutum, TJ. 8. and B. P.), 
which contains about 2 per cent, of the drug. It must be kept in dark, 
tightly-stoppered bottles. 

Physiological Action. — This is one of the most rapid (if not the most 
rapid) of the lethal poisons, only being approached by carbolic acid and 
nitrobenzole in the violence of its effects. Owing to its volatility, it is 
absorbed with great rapidity, and acts upon the respiratory centre and 
the heart, being eliminated almost immediately afterward. Because of 
its fleeting character, the survival of a patient twenty or thirty min- 
utes after the ingestion of a poisonous dose is a favorable sign for his 
recovery. 

The drug is an active paralyzant and exerts a lethal influence over 
every part of the body. The nervous system, heart, respiration, brain, 
and all vital parts are killed at once if much of it is present. 

Poisoning. — When a lethal dose of hydrocyanic acid is taken, death 
either comes at once, so that the person drops dead to the floor with a 




Tracing of the deep stormy respirations of an animal under the Influence of hydrocyanic acid. 
(After Schmiedeberg.) I. Normal respirations; II. Acid inhaled: III. violent deep res- 
pirations; IV. Arrest of respiration. 



gasp, is for ;i moment convulsed, the face cyanotic, the eyes wide open, 
with the teeth tightly shut, and the lips covered by a bloody froth, or 






HYDROCYANIC ACID. 255 

three stages of poisoning may ensue if the dose has not been large enough 
to result in immediate death, owing to its slow absorption. In the 
first of these stages there are difficult respiration, slow cardiac action, 
and disturbed cerebration. In the second stage, which is convulsive, 
we find wild cries, dilated pupils, unconsciousness, vomiting, spasmodic 
urination and defecation, erections of the penis, and ejaculations of 
semen. In the third stage there are asphyxia, collapse, and paralysis, 
ending in death. The blood is found to be dark and venous-looking, 
but does not give the spectrum bands of cyano-hsemoglobin. These 
bands only appear when the drug is shaken with blood outside the 
body. 

The diagnostic signs of death from prussic acid are the odor of the 
body, the wide-staring eye, the clinched teeth covered with froth, and 
the livid, cyanosed face. If the body be opened, the odor of hydro- 
cyanic acid is marked, but this rapidly passes away, owing to the vola- 
tility of the drug. 

The only poison producing symptoms resembling those wdiich have 
just been described is nitrobenzole or essence of mirbane, which has 
a somewhat similar odor, but which is, however, more permanent, the 
odor remaining in the opened body for hours. 

Therapeutics. — Hydrocyanic acid is useful in cases of gastralgia of 
purely nervous origin, and in some cases of nervous vomiting, and in 
irritable stomach, where, owing to a hyperesthesia of the mucous mem- 
branes, the taking of food produces discomfort. 

In irritable coughs, due to tickling in the throat and bronchi, it is 
very extensively used, and has received high praise by those best 
qualified to judge. On the other hand, it has been claimed that owing 
to the extreme volatility of the drug it only acts for the moment, and 
that a dose every ten or fifteen minutes is necessary to produce any 
real effect. However this may be in theory, practically the acid cer- 
tainly does aid in relieving cough. In these states the following pre- 
scription will be found of service : 

R. — Acid, hydrocyan. dil f £j (4.0). 

Syrup, pruni virg f ^iij (96.0). — M. 

S. — Teaspoonful (4.0) every four or five hours to an adult. 

In enter algia or neuralgia of the intestines dilute prussic acid is 
often a very useful remedy. 

Externally, the drug is useful in pruritus and other forms of itch- 
ing skin diseases, and the following formula will be found of service 
in pruritus vulvce : 

R. — Hydrarg. chlor. corros gr. iss (0.09). 

Acid, hydrocyanic, dil f.^j (4.0). 

Aquse amygdal. amarse f,! v j (180.0). — M. 

S. — Poison ! For external use. Apply to the itching surface with a small rag. 

The same prescription may also be employed in pruritus without 
the bichloride, if so desired. The dose of dilute hydrocyanic acid is 
1 to 5 minims (0.05-0.35). In certain forms of irritable cough inhala- 
tions of the vapor ( Vapor Acidi Hydrocyanici) are recommended ; 
this is prepared by adding 10 to 15 minims (0.65-1.0) of the diluted 



256 DRUGS. 

acid to 1 flui drachm (4.0) of water, which is then placed in a suitable 
apparatus, from which is inhaled the vapor that arises. 

HYDROGEN PEROXIDE. 

Peroxide of Hydrogen is a clear, odorless, syrupy fluid of a 
specific gravity of 1.452, possessing a harsh, bitter taste. It is 
readily soluble in water, and its chemical formula is H 2 2 . Pure 
peroxide of hydrogen is never used in medicine, but in solutions 
of varying strength. The ordinary solution, as found in the shops 
and that now official (Aqua Hydrogenii Dioxidi, TJ. S., Liquor 
Hydrogenii Peroxidi, B. P.), is about 3 per cent., or, as it is gen- 
erally called, a 10-volume solution. This term, "10 volumes," sig- 
nifies that it can yield 10 volumes of available oxygen; and it is 
upon this yield of oxygen that its activity depends. The specific 
gravity of this official solution is 1.006 to 1.012 at 59°. The reaction 
is acid, but this is due to a small amount of acid added to the solution 
to preserve it. The official solution of peroxide of hydrogen, while 
the most stable that can be prepared, is nevertheless readily deterio- 
rated by exposure to heat, sunlight, or prolonged shaking. If placed 
in an absolutely clean, smooth glass vessel, it may be concentrated for 
immediate use by exposing it to a temperature of 140° F. ; but 
exposure to a temperature above this point may result in its decompo- 
sition with explosive violence. Practically, this means of concentra- 
tion is not convenient for the practitioner, and the ordinary official 
solution fulfils all ordinary requirements unless it has deteriorated by 
age. The great difficulty in the use of the solution of the peroxide 
is its liability to undergo change and become practically worthless. 
Wallian states that as a rough test for the value of a given solution a 
few crystals of permanganate of potassium may be placed in a test- 
tube, and 1 or 2 drachms (4.0-8.0) of the solution added. The vio- 
lence of the resulting effervescence is in direct ratio to its value as 
a remedial agent. 

Therapeutics. — The most valuable use of the peroxide-of-hydrogen 
solution in medicine is in the treatment of diphtheria. So far as we 
know, it is the best application for the destruction and removal of the 
false membrane. There is no injury to the normal tissues, nor is there 
the danger of poisoning which sometimes follows the use of such drugs 
as carbolic acid. Applied to the false membrane, there is at once an 
active effervescence with some local tingling of the part. The mem- 
brane can afterward be removed in shreds. The solution should 
be applied by means of a swab or spray, but if the hitter is used a 
glass atomizer must be employed, as the peroxide is decomposed by 
coming in contact with metals. Peroxide of hydrogen is also a very 
valuable application for cases of follicular tonsillitis with profuse exu- 
dation, to cleanse the parts prior to the use of guaiacol. (See Guaiacol.) 

In the treatment of abscess-cavities, tubercular or septic in char- 
acter, the peroxide of hydrogen is a very valuable application, and 
its use will often decide the presence of pus, since when it meets with 
this material active effervescence ensues; but care must be exercised 



HYOSCYAMUS. 257 

that free vent is allowed for the gas that is given off*, as if confined it 
will force the septic material into the surrounding healthy tissues. 
Similarly, it is a valuable preparation for cleansing ulcers and malig- 
nant growths which have ulcerated. 

The employment of the peroxide internally, with the idea that it 
will yield oxygen to the body in cases in which this gas is lacking in 
the blood, is futile. Even if the oxygen entered the blood, the 
amount disengaged from a possible dose would be too small to be of 
value. 

Hydrogen peroxide is a useful agent for the removal of powder- 
stains in recent cases. 

It is stated that the application of this liquid to the spot affected 
by a hornet's sting will give instant relief; and applied by means of 
an atomizer it is the best fluid to aid in the painless removal of adhe- 
sive strips. The part of the strip next to the skin should be sprayed 
as it is gradually pulled off*. It is also used on plaster-of-Paris dress- 
ings to soften the material so that it can be cut with a knife or shears. 

Where the peroxide is used as a gargle it may produce pain through 
its attacking cavities in the teeth or the metallic substances with which 
they are filled. 

Taken internally, the peroxide of hydrogen is not poisonous. The 
internal dose of the Aqua Hydrogenii Dioxidi of the U. 3. P. is 
from 1 to 4 drachms (4.0-16.0), well diluted with water, and taken 
from a porcelain, not a metal, cup or spoon. It possesses no distinct 
value in internal medication. 



HYOSCYAMUS. 

Hyoscyamus, U. S., or Henbane, is a plant of the Northern United 
States and Europe. The leaves (Hyoscyami Folia, B. P.) only are 
used, and from them are obtained two alkaloids — one known as hyos- 
cyamine, the other as hyoscine. The first has practically the same 
physiological action as atropine, save that it is much more sedative in 
its effects on the nervous system. (See Belladonna.) The second is 
quite different in its influence over the body. The only marked differ- 
ence in the action of hyoscyamine and atropine is in the mydriasis pro- 
duced by each. While that of atropine lasts, in man, from twelve to 
fourteen days, hyoscyamine generally remains for only seven to nine 
days. Sometimes the development of mydriasis is preceded by violent 
pain in the eye due to a cramp of the ciliary muscle. If so, the drug 
must be pushed to overcome trie spasm. The strength of the solution 
to be used is 2 grains (0.1) to the ounce (30.0). Owing to the presence 
of hyoscine in hyoscyamus, it is more quieting and depressing to the 
nervous system than is belladonna. 

Therapeutics. — Hyoscyamus is used in every condition indicating 
the employment of belladonna; or, in other words, wherever local 
spasm or arterial relaxation exists or where pain is due to spasm. 
It has been particularly recommended in nervous cough, in whooping 
cough, and in colic, and probably is better in its influences in these 
states than is belladonna. In combination with nitrate of silver the 
17 



258 DRUGS. 

extract may be used with advantage in chronic gastric catarrh and 
gastric ulcer. In urinary incontinence due to irritable bladder it is 
verv serviceable, and particularly is this true of this affection in chil- 
dren and old persons, provided that the urine is first rendered normal 
by the use of acidifying drugs or by the use of alkalinizing drugs if it 
is abnormally acid. 

Administration. — The drug itself is official in four forms and as 
hyoscy amine sulphate and hydrobromate. The dose of the tincture 
(Tinctura Hyoscyami, U. S. and B. P.) is 30 minims to 1 drachm 
(2.0-4.0) ; the alcoholic extract (Extr actum Hyoscyami, U. S., and 
Viride, B. P.), dose \ to 1 grain (0.02-0.05) ; the alkaloid (Hyoscya- 
mince Sulphas, U. S. and B. P., vel Hydrobromas, U. S.), dose 
g 1 ^ to J=q of a grain (0.001-0.0015) ; and the fluid extract {Extr actum 
Hyoscyami Fluidum, U. S.), dose 5 to 30 minims (0.35-2.0). The 
B. P. preparation, besides those given, is the juice (Succus Hyos- 
cyami), dose 30 minims to 1 fluidrachm (2.0-4.0). 

Hyoscine. 

This is one of the alkaloids derived from hyoscyamus, and is a 
thick, syrupy alkaloid which forms a crystalline salt with an acid. It 
is a powerful nervous sedative in some cases. Much if not all the so- 
called hyoscine of the stores is in reality scopolamine, derived from 
Scopolia atropoides. 

Physiological Action. — Hyoscine quiets the cerebrum and produces 
deep sleep in a certain class of patients. In the lower animals or in 
man it may cause sleep or wild delirium. It causes loss of reflex 
action in overdose, which is due to depression of the spinal cord and 
not of the nerve-trunks. Upon the circulation it has little effect, but 
it is worthy of note that it influences the vagus nerves, as does atropine, 
stimulating them at first, but finally depressing them, although the 
contrary has been asserted. In any event, the circulatory effect is 
a minor one. In cases where hyoscine has acted in excess, or where 
an overdose has been given, pilocarpine may be used as a physiological 
antidote in full doses if the heart is sound. 

Therapeutics. — Hyoscine is of value as a hypnotic in a very limited 
class of cases, and in this class generally acts most favorably. These 
cases consist of those who, from acute mania, hysteria, or similar cause, 
suffer from insomnia, and perhaps struggle violently against proper 
control or refuse to swallow or retain food. 

The drug may be given to such persons hypodermically, in the 
dose of yj-g- to -gL- of a grain (0.0006), or by the mouth in the dose 
of -fa to -g^ of a grain (0.0008). The fact that it possesses no 
taste and is small in bulk renders it readily employed. In some 
persons it utterly fails even in this particular type of cases. 1 In 
delirium tremens it may cause evidences of cerebral congestion and 
Cheyne-Stokes breathing. Some patients are not quieted by the 

1 The writer has given one-tenth of a grain of Merck's hyoscine in twenty-four 
hoars, obtaining it from two different and reliable sources, without producing sleep, 
although the respirations were much quickened. 



HYPNAL—ICHTHYOL. 259 

drug, but pace up and down in a semi-sane condition until its action 
wears off. In the opinion of the writer the applicability of the drug 
is very limited indeed, and untoward effects are common. 

Hyoscine is of great value in some cases of spermatorrhoea and noc- 
turnal emissions if given in the dose of y^ grain (0.0006) at bedtime. 

The drug is contraindicated in the sore throat of scarlet fever, as 
it may cause a sensation of pharyngeal constriction. In the insomnia 
of heart disease with nervousness it will cause sleep, but may also 
produce death by respiratory failure or cardiac arrest, and it is to be 
remembered that the drug will produce asthma rather than relieve it. 
The breathing in some persons may become under its influence croupy 
or rasping. 

Hyoscine is an uncertain remedy in nervous affections, sometimes 
acting very well, at others producing very alarming symptoms in 
cerebration, circulation, and respiration. 

Hyoscine is official in the form of Hyoscine Hydrobromate (Hyos- 
cince Hydrobromas, U. S.) and in the B. P. as Hyoscine Hydrobro- 
mide (Hyoscinos Hydrobromidum). 

HYPNAL. 

The chemical name of this substance is monochloral-antipyrine, 
and it is, as its name indicates, a compound of chloral and antipyrine. 
There is also a dichloral-antipyrine, which contains more chloral. The 
compound is employed in treating those patients who suffer from pain 
and insomnia combined, the antipyrine relieving the pain and the 
chloral producing sleep. Opium is the only drug known which can 
be relied upon to act in this double manner, and the disadvantages of 
that medicament are often so prominent as to prevent its use. The 
drug has been used in neuralgic insomnia, but for some reason has not 
proved as popular as was expected when it was introduced. The dose 
is from 5 to 20 grains (0.35-1.3), best given with simple syrup and 
water or with syrup of orange-peel, or it may be used as follows : 

R.— Hypnal gr. xv (1.0). 

Chartreuse f^j (4.0). 

Distilled water f§ss (16.0).— M. 

S. — The entire amount to be taken in one dose. 



ICHTHYOL. 

The substance sold in the shops and employed in medicine under 
the name of ichthyol is really a salt formed by the bibasic acid, 
ichthyo-sulphuric or sulpho-ichthyolic acid with ammonium. In other 
words, it is ammonium ichthyol, which is a semi-solid substance. The 
ichthyo-sulphuric acid itself is derived from a crude oil, which in turn 
is obtained by destructive distillation from a deposit of fossil fish found 
in the Tyrol Mountains. When combined with sodium, forming sodium 
ichthyol, a more solid substance than ammonium ichthyol is formed, 
which can be employed if it is desired to use the drug in pill form. 



260 DRUGS. 

Both the ammonium and sodium ichthyol contain about 10 per cent. 
of sulphur, and it is largely upon this that their therapeutic activity 
depends. They are both soluble in water, and have a dark-brown, 
tarry appearance. Their disagreeable odor depends upon an inseparable 
volatile oil. 

Therapeutics. — Ichthvol is without doubt one of the most remark- 
able substances introduced for medicinal purposes within the last few 
years, both because of its curious origin and its therapeutic value in a 
large variety of ailments. In the author's hands it has proved most 
efficacious in the treatment of the inflamed areas in acute articular 
rheumatism. When used in this disease an ointment composed as fol- 
lows is to be smeared over the inflamed part, and then spread on lint, 
which is wrapped about the limb. This usually relieves the pain and 
tenderness of the part to a great extent. The same application, accom- 
panied by rubbing or applying massage to the joint, is of value for the 
pain and stiffness met with after the acute manifestation of the disease 
has passed by : 

R.— Ichthvol 3ss (15.0). 

01. ci'tronellas gtt. xv vel xxx (1.0-2.0). 

Adipis vel lanolini 3J (30.0). — M. 

The same prescription is also the best external treatment of ery- 
sipelas that we have. The skin should be carefully and gently 
washed, and then anointed with the ointment and covered by lint 
smeared with this ointment. If the disease be in the skin of the face, 
holes are to be cut in the lint for the mouth, nose, and eyes. Ichthyol 
is also a very useful drug in the treatment of chronic skin diseases 
associated with atony and induration of the deeper layers of the skin, 
such as acne, eczema, and even lupus and keloid in their chronic 
stages. It is always better to use ichthyol in ointment form, but some 
practitioners have employed it by painting it on in watery solution 
with a earner s-hair brush. In frost-bites, chilblains, and in burns it 
is of service, and Agnew recommended it highly when rubbed into 
lymphatic enlargements. Ichthyol has proved remarkably efficacious 
in removing peri-uterine and other pelvic exudations when used as a 
salve with pelvic massage or in a vaginal suppository. 

For acute sprains, and for the removal of the swelling following 
such injuries, its influence is extraordinary if it be well rubbed into 
the part affected. 

In severe cases of cracked nipples, with much induration, an oint- 
ment of ichthyol, 1 drachm to 4 (4.0-16.0) of lanolin, will prove of 
value, but it must be wiped off before each nursing or the child will 
not take the breast. Often the odor remains and prevents nursing. 

The dose of ichthyol internally is 1 to 10 grains (0.05-0.65), given 
in pill. 

[chthyol is a very useful remedy for the treatment of foetid ozcena. 
i>y(> Nasal Catarrh, Atrophic, Part IV.) 

IODIDES OF AMMONIUM AND ETHYL. 
(See Ammonium and Ethyl Iodide.) 



IODIDE OF POTASSIUM. 261 



IODIDE OF POTASSIUM. 



The physiological effects of iodide of potassium (Potassii Iodidum, 
U. S. and B. P.) are entirely comparable to those of iodine itself 
(see Iodine), but it is employed for somewhat different purposes, is 
less irritant, more readily given, and perhaps more readily absorbed. 
When it is given in very large doses or for a long period of time, the 
fact that the potassium base is a depressant poison is to be remembered, 
and it is well to use iodide of sodium instead. 

Physiological Action. — Circulation. — Upon this part of the sys- 
tem when in health iodide of potassium produces effects differing very 
slightly, if at all, from those caused by potassium itself. Small 
amounts raise the blood-pressure, and large quantities lower it (Prevost 
and Binet), but if atheroma of the blood-vessels be present with high 
arterial tension in association with it, iodide of potassium acts as a valu- 
able remedy in reducing the vascular spasm. It therefore lowers arte- 
rial pressure. 

Absorption and Elimination. — Iodide of potassium is very 
rapidly absorbed and eliminated, appearing in the urine, according to 
Doux, in thirteen minutes after it is ingested, and the daily amount 
excreted equals about 80 per cent, of the dose taken. Some of the 
drug tends to accumulate in the body. It is evident, therefore, that 
in the use of iodide of potassium we should give it freely and fre- 
quently at first until the residual amount has reached its limit, when 
smaller doses may be given, and given less frequently, for the purpose 
of maintaining the iodine influence. That is to say, the drug should 
be given up to the point of tolerance, whatever that may be, and ^then 
a smaller dose will be sufficient to maintain its influence by replacing 
the albuminoid compounds of iodine as they are slowly eliminated. On 
the other hand, if the iodide is being given for the purpose of elimi- 
nating some poison, as lead, for example, here the dose cannot be greatly 
decreased, because in addition to the ordinary quantity eliminated 
a portion is passed out as a double soluble iodide of lead. This 
theoretical deduction seems to find support in the fact that after the 
syphilographer reaches the full effect of the drug he often cuts the 
dose down to what he calls the "tonic dose," and so maintains the 
constant alterative effect without disordering the functions of the 
body. If he does not do this, the drug accumulates and causes 
chronic iodine cachexia, a state which it is important to avoid in 
grave diseases, like syphilis, which depend for their relief so largely on 
the maintenance of great vitality in the patient. All traces of the 
iodine in the urine disappear four or five days after the last dose is 
administered (Elhers). 

Therapeutics. — The medicinal uses of iodide of potassium may be 
divided into three great divisions, each of which is important. It is 
also employed for many conditions not included in these classes : 

1. Syphilis. — The use of iodide of potassium in syphilis is recog- 
nized as a part of all treatment for its relief. Elsewhere Dr. Martin 
has, in his excellent article (see Syphilis), treated of this question, 
and it is only necessary to call attention to the fact that the drug 



262 DRUGS. 

is generally well borne in large amounts by advanced syphilitics, 
although this is not always the case. The term " therapeutic test" 
is applied by one eminent teacher to signify a state of the system 
produced by syphilis in which a diagnosis may be made by the fact 
that large doses of the iodide are borne without inconvenience. This 
resistance does not always prove the presence of syphilis, nor does the 
absence of this resistance prove the absence of this disease. Persons 
having hereditary asthma, gout, rheumatism, or some similar diathetic 
malady often resist the iodide, and, on the other hand, some syphilitics 
are aifected with " iodism " after very small doses. In treating syphilis 
the drug should be used in the dose of 10 grains (0.65) three times a 
day, and this amount gradually increased a grain a day until symp- 
toms of "iodism" occur. 

The quantity borne often amounts to from 100 to 200 grains 
(6.0-13.0) a day, and as much as 400 grains may be taken by some 
persons. The best way to use the iodide of potassium is to order for 
the patient a saturated solution of the drug, which contains in each 
drop about 1 grain, and at the same time a bottle of the compound 
syrup of sarsaparilla. To a tablespoonful of the latter the patient is 
to add the iodide solution, beginning with 10 minims (0.65) three times 
a day, and increasing a minim every twenty-four hours. 

The iodide acts more slowly as an antisyphilitic than does mercury. 

In tertiary syphilis the iodide is invaluable. 

In nervous syphilis, be its manifestations what they may, iodide of 
potassium is the standard remedy, being supplanted by mercury only 
when it is necessary to break down a growth whose existence is a daily 
menace to the patient's life, as, for example, a brain tumor which causes 
pressure near vital areas. It is not curative in sclerotic post-syphilitic 
changes nor in locomotor ataxia due to syphilis, except in the earliest 
stages, because destroyed ceils cannot be restored, but it can be used 
to arrest further advance of the disease. It may greatly improve the 
patient's condition by preserving cells not as yet entirely destroyed. 

The therapeutic effect of this drug is much increased if hot vapor 
baths are used simultaneously with its internal administration. 

2. Metallic Poisoning.— Owing to the fact that iodide of potas- 
sium forms soluble double salts with all the metals in the tissues in 
chronic poisoning, thereby aiding in their elimination, it should always 
be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 

3. Antirheumatic. — Iodide of potassium is best suited, not to 
acute articular rheumatism, when the joints are very hot and 
painful, but to the secondary or subacute types, when the joints 
are large and the case "hangs on" — now better, now worse. It acts 
best, under these circumstances, if combined with wine of colchicum- 
ro« t. (See Rheumatism.) It is also to be tried in sciatica, lumbago, 
and rheumatic neuralgia, and it may be employed in chronic pleurisy, 
pericarditis, and hydrocephalus to cause absorption of the fluids. In 
these conditions, however, it often fails and cannot be relied upon. 

In aneurism, particularly that of the aorta, the drug often does 
good, but its value rests largely upon the cause of the disease. If 
it is due to syphilis, the aneurism may speedily cease to grow 



IODIDE OF POTASSIUM. 263 

under its influence, and the pain, swelling, and pulsation gradually 
decrease. 

In asthma iodide of potassium is valuable if the disease is of the 
pure bronchial type, but it ought not to be employed if the cause is 
associated with gastric irritation or indigestion, as it makes the condi- 
tion of the stomach worse. In bronchitis and intestinal catarrh where 
the condition of the mucous membranes is semi-chronic, and not relieved 
by chloride of ammonium, iodide of potassium should be used. If the 
bronchitis is chronic and the secretion profuse (bronchorrhoea), iodide 
of potassium will make it worse. The dose for an adult in all these 
instances should be about 3 to 5 grains (0.15-0.30) three times a day, 
for small doses tend to increase secretion far more than large ones, 
which often seem to decrease it. In pulmonary emphysema iodide 
of potassium is often of great value. 

In chronic interstitial nephritis small doses (5 grains (0.32) t. i. d.) 
are thought by some to check the disease, but it is to be remembered 
that the drug may produce untoward symptoms if the kidneys do not 
eliminate it, so that, if used at all, it must be given with great care. 
If the drug is well borne in chronic parenchymatous nephritis, it will 
cause an extraordinary increase in the urinary flow, and will often 
relieve very rapidly any dropsy which may be present. 

In bronchocele the employment of iodide of potassium internally 
and tincture of iodine externally is the best treatment we can use, and 
in acute coryza, or " cold in the head," 10 grains (0.65) taken at the 
beginning of the trouble will often abort the attack. 

In hepatic cirrhosis, in its early stages, the iodide often does good 
in arresting the overgrowth of connective tissue, and in arteriosclerosis 
or atheroma of the blood-vessels it is of great service. Thus in the 
latter conditions a combination of iodide of sodium or potassium with 
a little digitalis will relieve vascular spasm and support a feeble heart. 

A very important use of iodide of potassium is for the removal of 
enlargements of the cervical glands and those occurring in other parts 
of the body. In the later stages of pneumonia the iodides are useful 
to aid in the absorption of any exudates, but they are contraindicated 
in phthisis, except in the fibroid form and in those cases which are 
dependent upon syphilis as an underlying dyscrasia, as they aid in 
the breaking down of the lung. 

Untoward Effects. — In some persons, after the use of the iodide, 
coryza comes on, so that the edges of the eyelids become reddened and 
the nose runs constantly; and it is a curious fact that small doses 
are more apt to produce such a result than large ones. This is fol- 
lowed, if the drug is pushed, by the more positive signs of " iodism " 
spoken of under Iodine. 

In other cases acne breaks out on the face and disorders of diges- 
tion and gastric irritability come on. The acne can nearly always be 
prevented by giving arsenic at the same time with the iodide. In 
some cases petechial rashes break out on the legs, while in others 
great mental and physical depression appears, so that listlessness or 
melancholia may develop. Sometimes iodide of potassium causes 
diarrhoea. 



264 DRUGS. 

In persons susceptible to iodide of potassium care should be exer- 
cised when it is first administered lest sudden and dangerous oedema 
of the glottis occur. Eisner has reported a case in which death due to 
this cause followed the administration of 30 grains of the iodide of 
potassium. Multiple hemorrhages from the skin and mucous membrane 
occurred. 

If bullae or blebs follow the use of the iodides or other rashes 
appear, it is said that atropine will afford relief. 

Sometimes the iodide of ammonium or iodide of sodium will be 
borne when the iodide of potassium will not. 

Administration. — The iodide of potassium, owing to its exceed- 
ingly disagreeable taste, should be given with the compound syrup 
of sarsaparilla, as already described, with fluid extract of liquorice, or 
in milk. Large amounts of these vehicles are to be used. A good 
way to give it is to add the drug to one of the liquid pepsins, and then 
to add this to warm milk, as in the directions for the preparations of 
junket given in Part III. The curd largely covers the taste of the 
drug. The dose usually varies from 5 to 60 grains (0.32-4.0) three 
times a day, according to the condition of the patient. It is best given 
an hour after meals, so that it will not disorder digestion by irri- 
tating the stomach or interfere with the action of the gastric juice. 

One of the best ways to take the drug is in capsule, but if this is 
done a drink of milk or water or other fluid should precede or follow 
it, in order to prevent the drug from coming in contact with the 
stomach in concentrated form. The preparations of the iodide of 
potassium are — Unguentum Potassii Iodidi, U. S. and B. P., and the 
liniment (Linimentum Potassii Iodidi cum Sapone, B. P.). The 
former should always be freshly prepared. 

IODIDE OF SODIUM. 

Sodii Iodidum, U. S. and B. P., is used in the same doses and for 
the same purposes as the iodide of potassium, and is less irritant than 
the latter salt, as well as less depressant to the general system. 

IODINE. 

Iodum, U. S. and B. P., is a non-metallic element found largely 
in seaweed and in mineral iodates and iodides. It is soluble in ether 
and alcohol, but slightly so in water, and possesses an acrid, burning 
taste and a neutral reaction. 

Physiological Action. — The physiological action of iodine, so far as 
its alterative powers are concerned, is absolutely unknown. Applied 
to the skin, it stains it yellow, brown, or black according to the free- 
dom of its application, and it acts without pain if the skin is intact. 
If very large amounts are used, it produces vesication. Upon mucous 
membranes iodine acts as a powerful irritant. Germain-Se'e believed 
it to 1)0 a stimulant to the nutritive processes of the body and to the 
circulatory system, and he was certainly correct in regard to the influ- 
ence it exercises over nutrition. 

Absorption and Elimination. — The drug is rapidly absorbed, 



IODINE. 265 

escapes from the body chiefly through the kidneys, the skin, the sali- 
vary glands, and it even appears in the milk of nursing women to such 
an extent that the nursing infant may be affected by iodism and suffer 
from gastro-intestinal disturbance in consequence of ingesting it. 

Poisoning. — The symptoms of acute poisoning by iodine are those 
of acute gastro-enteritis, such as severe pain in the oesophagus, stomach, 
and abdomen, accompanied by violent vomiting and purging. An early 
symptom is the persistent strong metallic taste in the mouth, with 
markedly increased salivation. The pulse becomes rapid, running, and 
feeble, the face deathly pale, total arrest of urinary secretion takes 
place through renal irritation, and death occurs by failure of respira- 
tion, which is accompanied by loss of all vital power. 

If the poisoning is not severe enough to cause death at once, a 
fatal result is, nevertheless, reached after a few days by reason of 
the severe gastro-enteritis and the widespread fatty degeneration of the 
tissues which iodine produces. 

The treatment of the poisoning consists in the use of large amounts 
of starch in any of its forms as the antidote, the employment of 
emetics and the stomach-pump, the application of heat to the body 
and extremities, and, finally, the employment of hypodermic injections 
of alcohol, digitalis, and atropine or strychnine for the purpose of 
maintaining the strength of the circulatory and respiratory systems. 

Untoward Effects. — Under the name of "iodism" the profession 
recognizes a state of the body brought on by the prolonged and 
excessive use of iodine in any of its forms. The earliest notable 
signs of this state are a peculiar metallic taste in the mouth, par- 
ticularly before breakfast, slight tenderness of the teeth and gums, 
increase of salivary secretion, a little morning nausea and a lack of 
appetite for breakfast, and perhaps some coryza or evidence of gastric 
irritation. Acne rosacea often comes on very early during the use of 
full doses of iodine. If the drug is continued, all these symptoms 
become more marked and the coryza becomes intense. Headache 
under the frontal bone and sore throat often appear, and the pustu- 
lar and bleb-like changes in the skin go on to active suppuration. 
Sometimes large boils appear or purpura hsemorrhagica (iodic purpura) 
comes on. Slight catarrhal fever may develop. 

In other cases the nervous system chiefly suffers. Twitchings of 
muscles, neuralgic pains in the trunk and extremities, and wasting 
of the testicles, mammae, and all other tissues occur as the result of 
trophic disturbances. Anaemia amounting to an actual cachexia is 
commonly produced. Loss of vision and paralysis may ensue in 
extreme cases. Soullier asserts that albuminuria may be developed in 
children after tincture of iodine has been applied to the skin, by reason 
of its absorption and irritation of the kidneys. 

Therapeutics. — In all cases where the glandular system is in a state 
of chronic perverted functional activity, as in those diseases associated 
with disorder of the processes of nutrition, and often included under 
the single name of scrofulosis, iodine is of service. In enlargement 
of the lymph-glands it is, in its various forms, one of the best remedies 
we possess, but it ought not to be employed in those cases where rapid 



266 DRUGS. 

changes are going on in the gland, such as the formation of pus, since 
under these circumstances it will increase the size of the slough. 
Neither will it benefit the glandular enlargements of Hodgkin's 
disease or lymphatic leukaemia. The drug ought never to be used in 
rapid phthisis, because it tends to disintegrate the tissues, and this is 
precisely what the disease is doing. In the exceedingly chronic form 
of pulmonary disease known as fibroid phthisis iodine may often be 
used with advantage. When inhaled in fames it may be of service 
as a stimulant to the mucous membranes, but is never of value in 
phthisis so far as combating the true pathological change is con- 
cerned. In countries where goitre is very prevalent iodine ranks as 
a most efficient remedy, but it must be used with caution, and in case 
of exophthalmic goitre it is probably harmful in that the hyper- 
trophied gland probably produces some of its symptoms by excreting 
too much iodine. In cystic or vascular enlargement of the thyroid 
gland it is valueless, but in simple overgrowth of the connective 
tissue of the gland iodine is of some value. Sometimes it is injected 
by means of a hypodermic needle into the gland. The usual dose is 
10 to 15 minims (0.65-1.0) every second or third day till twenty or 
more injections have been used. Meltzer states that while this treat- 
ment is sometimes efficacious, it is not by any means devoid of danger, 
for at least thirty deaths have resulted from it. 

In chronic bone disease iodine applied about the affected joint in 
the form of the ointment diluted one-half with lard, or in the pure 
tincture, will be found of service, and if anoemia exists the syrup of 
the iodide of iron should be given internally. 

The other uses of iodine externally are many and important. As 
a slow counter-irritant, which does not produce pain if properly em- 
ployed, it is particularly useful in children, and may be employed in one 
to three coats, and no more, applied by means of a camel's-hair brush. 

The proper way to use the tincture of iodine as a local counter- 
irritant for adults is to give one good black coat at one sitting, and 
not to repeat it until the skin has desquamated and become well re- 
newed. If iodine is applied after desquamation of the skin has begun, 
it will cause agonizing burning pain, which nothing will relieve except 
the removal of the iodine by the use of cologne-water, alcohol, whiskey, 
or gin. The application of any of these liquids causes such an in- 
crease in the pain as to be almost useless after the skin is broken. 
The best solution for its removal is one of iodide of potassium, 
which should be followed by a starch poultice. A good rule to follow, 
is never to cause pain by the use of iodine, as the drug acts equally 
well if applied in such a way as to avoid suffering. 

A stronger and more active preparation of iodine in solution for 
external use is that recently suggested by Elsberg. This preparation 
is of 20 per cent, strength, whereas the ordinary tincture is about 10 
]»(')• cent. It is composed of iodine, 5 drachms (20.0); alcohol and 
ether, of each, 10 drachms (40.0). One or two coats of this solution 
painted upon the skin will produce as much effect as several of the 
ordinary tincture, and as it dries very rapidly it does not soil the 
clothing. 



IODINE. 267 

Iodine in the form of the tincture is applied as a counter-irritant 
paint to the skin of the chest in pleurisy, both to abort an attack and 
to aid in absorption of the fluid after it is passed out into the chest. In 
harassing irritative cough it may painted over the supraclavicular 
spaces, and it will sometimes lessen the secretion in chronic bronchitis 
if used in this way. In chronic rheumatism affecting the joints and 
muscles it does good when locally applied. Often in synovitis the 
local application of iodine causes increased swelling for some days. 
This should not cause alarm, for ultimately the swelling decreases 
very greatly, and the cases in which this occurs are generally the 
best from a prognostic point of view. 

In the course of phthisis every now and then a "spot" in the 
chest will become "sore," probably due to a limited area of pleurisy, 
and under these circumstances tincture of iodine locally applied will 
give relief. In lupus the tincture may be painted around the edges 
of the growth, and even over its surface, with the object of retarding 
its spread. In chilblains an application of iodine ointment gives the 
greatest relief if diluted one-half with lard, and its use is probably the 
most efficacious measure at our disposal. Iri certain individuals who 
have "pains in the chest" iodine ointment may do good if rubbed 
in over the affected spot. As has been pointed out by others, iodine 
does good if muscular tenderness is present, while it fails if pleuro- 
dynia or intercostal neuralgia is the cause of the suffering. The lat- 
ter troubles should be removed by the use of belladonna. In certain 
forms of skin diseases, such as tinea tonsurans and circinata, tincture 
of iodine may be applied with a camel's-hair brush, and even the 
entire scalp may be painted. A better way is to apply it to different 
spots each day. When erysipelas is present, the tincture may be painted 
around the edges of the inflammation in order to prevent its spread. 

In old persons or those in middle life retraction of the gums from 
the teeth sometimes comes on, and dentists recommend for this dis- 
order the use, by means of a camel's-hair brush, of a watery solution 
of iodine of the strength of 1 grain to the ounce (0.05 : 30.0), to be 
followed at once by a thorough rinsing of the mouth with pure water. 
In hydrocele iodine in the form of the tincture is the best drug for 
effecting a permanent cure that we have. The sac should first be 
emptied by the use of a trocar and canula, and the iodine alone or 
mixed with glycerin injected with a syringe, and then allowed to 
escape. As the pain produced by this injection is most atrocious, 
the patient should first be put under the influence of ether or other 
anaesthetic. 

Injections of iodine have been made into various serous cavities for 
the relief of chronic inflammatory processes. This is sometimes fol- 
lowed by bad symptoms, and after the injection of tincture of iodine 
into the pleural cavity in hydrothorax symptoms of poisoning have 
come on in some cases, the most common complication being con- 
vulsions. These are epileptiform in character and are followed by 
coma or collapse. 

In empyema a solution of iodine 6 grains (0.39), iodide of potas- 
sium 6 grains (0.39), and water 1 pint (500 cc.) may be used daily 



268 DRUGS. 

as an irrigating fluid with good results ; but this practice is not 
entirely devoid of danger, as too much of the iodine may be absorbed 
or the irritation produced in the chest by its injection may cause 
reflex and severe nervous symptoms. Iodoform is better. 

The tincture of iodine may be used, according to Ringer, as an 
inhalation with signal benefit in the following three instances : 

1. In the chronic forms of phthisis (fibroid lung). When the 
expectoration is abundant and when the cough is troublesome, its 
inhalation, used both night and morning, will generally lessen the 
expectoration and allay the cough. 

2. In children six to ten years of age, who after meals, or, inde- 
pendently of them, on exposure to cold, are seized with hoarseness, a 
hoarse, hollow cough and some wheezing at the chest. This affection, 
involving the larynx, trachea, and larger bronchial tubes, and often 
proving very obstinate, is apt to return and to persist a considerable 
time. 

3. Some persons suffer with itching of the nose, of the inner canthus 
of one or both eyes, sneezing, running at the nose of a watery fluid, 
weeping of the eyes, and severe frontal headaches ; and these patients 
of various ages are greatly troubled, often for many years, with daily 
attacks of this character, lasting, it may be, several hours. Iodine 
inhaled often removes this affection at once, lessening the headache 
and discharge from the nostrils. Its effect is most marked in respect 
to the itching. 

Ringer generally adopts the following simple, handy, cleanly, and 
effectual plan of inhalation : Heat well a jug capable of holding about 
2 pints, by rinsing with boiling water, then partly fill with boiling 
water, into which pour 20 to 30 minims (1.3-2.0) of the tincture of 
iodine, then direct the patient to put his face over the mouth of the 
jug and breathe the iodized steam, covering the head to prevent the 
escape of the vapor. This inhalation should be used night and morn- 
ing for five minutes or a little longer. Occasionally an excess of 
iodine will temporarily produce a sensation of soreness in the chest 
and throat, accompanied with redness of the conjunctiva, running 
from the nose, and pain in the head. 

In some cases of acute coryza much relief may be obtained by sniff- 
ing the fumes of tincture of iodine from a bottle, as in the use of 
" smelling salts." The heat of the hand is sufficient to disengage the 
vapor in proper quantity. 

Administration. — Iodine is never used in solid form, and it .has 
been taught that the tincture (Tinctura Iodi, U. S. and B. P.) should 
not be given internally, on the ground that it is precipitated in the 
stomach. Whether this be true or false, it is a fact that the tincture 
has recently been largely used in the vomiting of pregnancy and after 
anaesthetics with very good results. The dose is 5 to 10 minims (0.35- 
0.65), well diluted. Under the name of Lugol's solution {Liquor Iodi 
Oompo8itu8, l r . S.) iodine is frequently used internally; the dose is 5 
to 10 minims (0.35-0.65), in water. Liquor Iodi fortis, B. P., is 
used as a liniment or local application. 

Unguentum Iodi, U. S. and B. P., is used locally over enlarged 



IODOFORM. 269 

glands. In the case of children or adults who have delicate skins the 
ointment should be diluted one-half with lard. This ointment should 
always be freshly made. 

Contraindications. — Iodine is contraindicated in renal diseases, 
except in small doses, during the progress of acute inflammation, and 
whenever tissues are rapidly undergoing a breaking-down process. 

IODOFORM. 

Iodoform (Iodoformum, IT. S. and B. P.) occurs in small saffron- 
colored crystals which possess a powerful characteristic, penetrating 
odor and strong taste. It is soluble in alcohol, ether, chloroform, 
benzol, and in fixed and volatile oils, but is insoluble in water. 

Physiological Action. — The effects of iodoform upon the circulation, 
respiration, and other vital functions are very slight when the drug is 
used as a surgical dressing in ordinary amounts or when it is given by 
the mouth in average doses. It acts as an anaesthetic upon mucous 
membranes, and produces those changes which we are wont, for want 
of a better term, to call "alterative," in the tissues with which it 
comes in contact. Iodoform is eliminated in the urine as iodine or as 
alkaline iodides, chiefly iodide of sodium. The drug also escapes by 
the saliva as an alkaline iodide. 

Poisoning. — If applied to an absorbing surface in susceptible indi- 
viduals, iodoform may cause general systemic poisoning. This poison- 
ing may be mild, in which case we have a general feeling of malaise, 
with nausea and the perception of various odors which are in reality not 
present. There may be headache and vomiting. If the system is still 
more impressed by the drug, these symptoms are followed by cerebral 
excitement, insomnia, loss of memory, loss of appetite, and a rapid 
pulse. In very grave cases convulsive movements and maniacal delir- 
ium, alternating with coma, may be the dominant symptoms. The 
pulse is small and rapid, and there is often retention of urine or hema- 
turia. Loebisch asserts that the mental excitement cannot be quieted 
by narcotics. If death occurs, the heart and respiration fail simultane- 
ously. In addition to the fatty degeneration which such poisoning pro- 
duces in all the vital organs, there is sometimes found an cedematous 
condition of the pia mater or a low-grade leptomeningitis. These 
symptoms seem to occur more commonly in the aged. In the graver 
cases the onset of the poisoning is apt to be sudden, though from 
twenty-four hours to several days usually elapse between the appli- 
cation of the drug and the onset of the symptoms of poisoning. 

Treatment of the poisoning by iodoform consists, according to Soul- 
lier, in the administration of bicarbonate of sodium to unite with the 
iodine and so aid in its elimination ; the use of alcoholic stimulants to 
support the system ; the employment of diuretics, and wrapping the 
patient in hot blankets to encourage free sweating, so relieving the 
kidneys. Kocher advises saline transfusion in such cases. 

Untoward Effects. — It is not to be forgotten that iodoform when 
applied as a dressing may produce less violent symptoms than those just 
described, and capable, because of their aberrant character, of seriously 



270 DRUGS. 

misleading the physician. Thus a scarlatinal rash may develop with 
fever, malaise, and nervous disturbances. 

Therapeuties. — Iodoform is used chiefly as a surgical dressing, but 
is by no means as popular for this purpose as it was at one time. It 
is antiseptic, but not germicidal. Germs may be found in powdered 
iodoform, and will even grow in it. When used locally, the drug does 
good by absorbing the liquids of the wound, and thereby removing the 
nidus for germ-growth, and when applied to large moist surfaces gives 
off free iodine and acts as well as a protective. There can be no doubt 
that iodoform when applied to a wound does good, not by destroying 
the bacteria directly or indirectly, but by inducing chemical changes 
in their toxines. 

In syphilitic sores the following dressing will be found of great 
service: Iodoform, 20 grains (1.3); oil of eucalyptus, J fluidounce 
(16.0); or a powder of iodoform J an ounce (16.0), camphor 75 
grains (5.0), and essence of roses 2 drops (0.1), may be employed. 
In eczema, with tingling and itching, the following application will 
give relief (Ringer) : 

R. — Iodoformi , gr. iv (0.2). 

Olei eucalypti r%j (4.0). 

Petrolati Jj (32.0).— M. 

S. — Apply locally. 

Internally, iodoform is used in tertiary syphilis in all its forms in 
the dose of from 1 to 5 grains (0.05-0.35). Bartholow recommends 
it most highly in catarrhal jaundice and in the early stages of hepatic 
cirrhosis. 

The influence of iodoform upon the tubercle bacillus is very great, 
and it is now largely used in the treatment of tubercular disease of the 
joints and pleurce. The pus is allowed to escape under antiseptic pre- 
cautions ; the cavity is washed out with warm boric-acid or carbolic-acid 
solutions of low strength, and from 1 to 6 drachms (4.0-24.0) of an 
emulsion of iodoform and sterilized sweet oil are injected and allowed 
to remain. The strength of the iodoform-and-oil emulsion should 
usually be 10 per cent. Should the abscess-cavity fail to heal after 
these injections have been repeated every few days for some time, it 
must be reopened, scraped, and injected again or packed with iodoform 
gauze. The iodoform also promotes healing through its alterative influ- 
ence, which aids in the absorption of the inflammatory exudate. Should 
tubercular glands be present, injections maybe made into them even if 
pus has not formed. 

Used by means of a powder-blower, iodoform will often relieve the 
hoarseness and discomfort of laryngeal phthisis, but it must be pulver- 
ized most minutely. Sometimes a spray may be used, which should 
consist of spirits of turpentine and sweet oil, half-and-half, and contain 
2 grains (0.10) of iodoform to each ounce (32.0). This mixture may 
also be used in chronic bronchial catarrh to lessen the cough and foetid 
discharge. In the early stages of phthisis several clinicians claim to 
have reached very good results by the daily hypodermic injection into 
the back of 30 minims (2.0) of a 1 : 100 solution of iodoform in oil of 



IODOL— IPECACUANHA. 271 

sweet almonds, but this treatment has not generally found favor, in this 
country at least. 

For fissure of the anus and irritated hemorrhoids 5 grains (0.35) 
of iodoform in a suppository may be placed in the rectum, and after it 
has remained there a few minutes defecation may he had without pain. 
The pain following operations on the female perineum may also be much 
relieved in this manner. In the tenesmus of cholera infantum an injec- 
tion of 1 ounce (32.0) of sweet oil with 5 grains (0.35) of iodoform will 
give great relief if used after or before enteroclysis. 

Administration. — The ointment of iodoform ( TJnguentum Iodoformi, 
II. S. and B. P.) is useful when applied over foetid sores. It should 
always be freshly made. The drug itself may be given in 1- to 5-grain 
(0.05-0.35) doses three times a day. The suppositories (Suppositoria 
Iodoformi) are official in the B. P. ; each one contains 3 grains (0.15) 
of iodoform. (See also Nosophen, Europhen, and Aristol.) 

IODOL. 

This is a dark, dirty-yellowish-looking powder, soluble in alcohol, 
ether, and oils, but only slightly so in water. Its uses in medicine 
are identical with those of iodoform, and it possesses the advantage 
of being not so penetrating in odor as the latter drug. 

In tubercular laryngitis the very finely powdered drug may be 
blown into the larynx without disagreeable results and with a favor- 
able effect on the disease process. Cerna has found iodol of very 
great service in diabetes when given internally, in the dose of from 2 
to 6 grains (0.1-0.3) three times a day, and it is said to be of value in 
tertiary syphilis in the same quantity. 

A very useful antiseptic dressing for small wounds and abrasions 
is made by adding 1 part of iodol to 10 parts of ether and 5 of gun- 
cotton, thereby preparing an iodol collodion. 

Ingalls recommends the following prescription in cases of eczema 
or abrasions of the upper lip and nostrils : 

R.— Acid, carbolic TT|v (0.3). 

01. rosse . Tr\y (0.3). 

Iodol gr. xxv (1.65). 

Lanolin jfss (15.0).— M. 



IPECACUANHA. 

Ipecacuanha, TJ. S., or Ipecacuanhas Radix, B. P., or Ipecac, is 
the root of Cephaelis Ipecacuanha (Psychotria Ipecacuanha, B. P.), 
a small shrub of Brazil. It contains an alkaloid, emetine, and ipecac- 
uanhic acid. 

Physiological Action. — Locally applied to mucous membranes, ipe- 
cac acts as an irritant, and if applied for a long period to the skin 
produces vesicles and irritation. Very minute doses have little notice- 
able effect, but large ones produce nausea, relaxation, vomiting, free 
secretion into the bronchial tubes, and a profuse flow of saliva. The 



272 



DRUGS. 



emesis is due both to the irritation of the stomach and to an effect 
upon the vomiting centre in the medulla (Fig. 47). The drug acts as 
a depressant to the spinal cord (Pecholier), and it also depresses the 
heart if given in large doses and retained by the stomach long enough 
for it to be absorbed. Ipecac is eliminated by the kidneys, the gas- 
trointestinal mucous membrane, and the skin (Binz). 

Fig. 47. 




A, Vomiting centre in medulla stimulated by ipecac ; B, nerves in mucous membrane of stom- 
ach irritated by ipecac. 



If emetine is given in lethal dose to one of the lower animals, death 
is due to failure of respiration. 

Therapeutics. — Ipecac is used as an emetic where a fairly rapid 
action is required. It is particularly useful in cases where the stom- 
ach of a child is overloaded with food. In cases of poisoning it is 
hardly active or rapid enough as an emetic, and is not as good as 
mustard or sulphate of zinc. In babies and young children an attack 
of bronchitis often causes digestive disorders, by reason of the mucus 
coughed up from the lungs being at once swallowed instead of spit 
out of the mouth. In these cases the stomach may be relieved and 
the state of the lungs improved by the use of an emetic dose of 
syrup of ipecac, 2 to 3 drachms (8.0-12.0). Often if the dose be not 
large enough to produce emesis it will purge the child and remove the 
mucus by the bowel. 

In some cases of obstinate vomiting small doses of ipecac will act 
as a most successful cure, provided that the vomiting is due not to 
inflammation and excitement, but to depression. The irritant effect 
of the ipecac stimulates the depressed stomach to a normal tone. 
The proper dose of ipecac for this purpose is | to J a grain (0.016- 
0.03) or less every half-hour until five or six doses are taken. 

In some cases of the vomiting of pregnancy it is very useful, in 
others it utterly fails. 1 minim (0.06) of the wine or J to \ grain 
(O.D14-0.016) of the powdered ipecac, repeated every half-hour for six 
or seven doses, is all that should be used. In the morning vomiting of 



IPECACUANHA. 273 

drunkards ipecac is of service, but it is not so good a remedy as are 
small amounts of arsenic or hydrochloric acid. 

Ipecac is also said to possess marked oxytocic properties, similar to 
quinine, when given in small doses, 10 to 15 minims (0.65-1.0), of 
the wine every two or three hours. 

In true acute dysentery ipecac is one of the best remedies we pos- 
sess. When the passages are large and bloody and the disease is 
malignant, as it occurs in the tropics, ipecac should be given in the 
following manner : The powdered ipecac is to be administered in the 
dose of 30 grains (2.0) with deodorized laudanum, which is used to 
decrease the tendency to vomit. Absolute rest is essential for suc- 
cess. Finally a profuse gray, mushy stool is passed. The passage of 
this stool is a most favorable prognostic sign, and its non-appearance 
is equally significant of failure. Counterirritation is to be applied to 
the belly, and stimulants freely used to avoid great depression. In 
choleraic diarrhoeas and cholera morbus ipecac is often of great service 
in the dose of 3 grains (0.2) every two hours. 

No less a person than Trousseau asserted that ipecac was a haemo- 
static^ and it is said to be a most effective remedy in small doses in 
haemoptysis, and in all hemorrhages which are capillary in character. 

Ipecac may be used in the early stages of bronchitis, to act as a 
sedative to the inflamed mucous membrane and to promote secretion. 
Under these circumstances it is best combined with citrate of potas- 
sium. (See Bronchitis.) 

Ringer and Murrell have found that inhaling ipecac spray is very 
useful in chronic winter cough or bronchitis, particularly when there 
is present shortness of breath. The pure wine may be used in a 
spray apparatus or be diluted one-half with water. While the throat 
may seem temporarily worse, the shortness of breath rapidly decreases 
and a great improvement takes place in the cough. In order to pre- 
vent the wine which collects in the mouth from being swallowed, and 
nausea and vomiting thereby induced, the patient should be directed 
to rinse his mouth thoroughly every few minutes. The inhalation 
should not last at first over three or four minutes, and, until it is 
known how well the patient will bear the application, the wine should 
be diluted twice or thrice with water and alcohol, equal parts. 

It is stated that powdered ipecac made into a paste and smeared on 
the skin will greatly relieve the pain and swelling produced by the 
stings of bees. 

Administration. — The syrup (Syrupus Ipecacuanhas, U. S.) is given 
in the dose of J to 1 drachm (2.0-4.0) as an expectorant, or in the 
same dose as an emetic to an infant. The wine ( Vinum Ipecacuanha?, 
B. P.) is given in the same dose as the syrup, and the fluid extract 
(Extractum Ipecacuanha? Fluidum, U. S. ; Extractum, Ipecacuanhas 
Liquidum, B. P.) in the dose of 30 minims (2.0) as an emetic to an 
adult. The troches (Trochisci Ipecacuanhas, U. S. and B. P.) con- 
tain 1 of a grain (0.016) each. Trochisci Morphinas et Ipecacuanhas, 
U. S. and B. P., each of which contains ^ of a grain (0.002) of mor- 
phine and -^ of a grain (0.006) of ipecac, are used in sore throat, dis- 
solved in the mouth. Dover's powder (Pulvis Ipecacuanhas et Opii, 

18 



274 DRUGS. 

U. S. ; Pulvis Ipecacuanha} Compositus, B. P.) is given in the dose of 
5 to 15 grains (0.35-1.0). It contains 1 part (0.05) of opium, 1 part 
(0.05) of ipecac, and 8 parts (0.4) of sugar of milk. (See Opium.) 

Emetine may be given in the dose of -^ to J grain (0.006-0.012) 
as an emetic, but is very rarely so employed. 

The British preparations are the pill of ipecac and squill (Pilula 
Ipecacuanha cum Scilla, B. P.), which is given in the dose of 5 to 10 
grains (0.35-0. 65), and the vinegar of ipecac (Acetum Ipecacuanha}, B. 
P.), which is given in the dose of 5 to 30 minims (0.3-2.6), and used 
as expectorants. 

IRON. 

Iron (Terrum, U. S. and B. P.) is a metal which is used both^as a 
medicine and a food — a food because it forms part of the body when 
taken into the organism and is used by the system in the making of 
blood. The number of its official salts and compounds is far in excess 
of the needs of practical physicians, and half the preparations are 
rarely, if ever, used. 

Physiological Action. — Iron has little or no eifect upon the system 
when given in a single dose, but repeated doses cause an increase in 
the number of red blood-corpuscles, and plethora, or an increase in 
the quantity and quality of the blood. Much discussion has arisen as 
to whether iron when given as a drug in the form of one of the inorganic 
salts is absorbed. One theory has been that only the organic iron of 
the food is absorbed, and that metallic iron when given freely allows 
this absorption to go on both by stimulating the bowel and by enter- 
ing into combination with the sulphuretted hydrogen in the intestine, 
thus permitting the organic iron to escape into the system. That both 
forms of iron are absorbed and eliminated is now certain. (For a 
discussion of some of these views see article on Anaemia.) If, however, 
iron is given in excessive doses, much of it remains unabsorbed, is 
changed into the sulphide of iron in the bowels, and escapes with the 
faeces. Careful studies have shown that the iron, when once absorbed, 
escapes from the body very slowly, and that its pathway of escape is 
not by the bile or in the urine, but by the walls of the intestine which 
excrete it, so that it may be recovered from the faeces. It has been 
asserted that it is never released from the body, but this is untrue. 
Whether it acts as a stimulant to blood-manufacture or simply supplies 
the glands with blood-making material we do not know, but the latter 
is probably the correct view. Iron causes oxidation to go on more 
rapidly by reason of its peculiar power of converting oxygen into 
ozone, and in this manner acts as a stimulant to nutrition and bodily 
activity. 

The preparations of iron consist in the soluble and insoluble salts 
or forms. Of these the insoluble are better than the soluble, because 
nearly all the soluble salts of iron are precipitated by the gastric juice 
and have to be slowly redissolved. Nearly all iron preparations are 
capable of acting as more or less powerful astringents, and so are apt 
to cause constipation and to disorder digestion if given in large doses. 
The most astringent of all of these preparations are Monsel's salt (the 



IRON. 275 

Ferri Subsulphas, IT. S., B. P.) and the sulphate {Ferri Sulphas, 
IT. S. and B. P.). Closely following these in astringency are the am- 
monio-ferric alum, {Ferri et Ammonii Sulphas, IT. S.) and the chloride 
of iron {Ferri Qhloridum). The least astringent preparations are 
Quevenne's iron, or iron by hydrogen {Ferritin Redactum, IT. S. and 
B. P.), and carbonate of iron {Ferri Carbonas Saccharatus, IT. S. and 
B. P.), and Basham's Mixture {Liquor Ferri et Ammonii Acetatis, 
IT. S.), and the citrates, tartrates, and the lactate and phosphate of 
iron. 

Therapeutics. — The chief indications for the administration of iron 
are those forms of anosmia (see Anaemia) characterized by a decrease in 
the normal quantity of haemoglobin in the blood as determined by the 
haemoglobinometer, as, for example, chlorosis. Its chief contraindica- 
tion is plethora. When used in small dose {\ to J- grain — 0.016-0.03) 
it is quite as efficacious as in large amounts, and less apt to disorder the 
stomach, but the doses given in this article are the classical ones 
usually prescribed by physicians. In some cases of anaemia of a semi- 
pernicious type large doses of iron are really needed, probably because 
the system is deranged in such a manner that an excessive loss or 
elimination of iron is constantly present. Large doses compensate for 
this leakage and afford the quantity needed for physiological purposes. 
It should not be used as a tonic unless some direct indication for its 
employment is present, and no drug is more abused in this respect than 
iron. As every preparation possesses some peculiarity, the use of each 
will be considered separately. 

Ammonio-ferric Alum. 

Ammonio-ferric Alum {Ferri et Ammonii Sulphas, U. S.) is often 
given in cases of atonic leucorrhoea associated with chlorotic tendencies 
in the dose of 2 to 5 grains (0.1-0.32). It is quite astringent, and 
should not be given in cases of gastric irritability, as it is not suited to 
such a condition. 

Aromatic Mixture of Iron. 

The Aromatic Mixture of Iron {Mistura Ferri Aromatiea) con- 
tains so little iron that it should not be administered in cases where 
a very marked chalybeate influence is desired ; it is, however, a useful 
tonic for cases of debility and slight anosmia following long illnesses, 
given in the dose of 1 to 2 fluidounces (30.0-60.0) after meals. Aro- 
matic mixture of iron contains cinchona-bark, calumba, cloves, iron, 
compound tincture of cardamoms, tincture of orange-peel, and pepper- 
mint-water. 

Arsenate of Iron. 
Arsenate of Iron {Ferri Arsenas, B. P.) is used in the dose of 
"IT *° "iV g ra ^ n m anaemic subjects who are suffering from the dry, 
scaly forms of skin disease which indicate the use of arsenic. (See 
Arsenic.) It is also of value in the anaemia of chronic diarrhoea, as 
both iron and arsenic are useful, not only for the anaemia, but for the 
control of the intestinal disorder. 



276 DRUGS. 



Bashanrs Mixture. 

Under the name of Basham's Mixture (Liquor Ferri et Ammonii 
Acetatis, U. S.) a very useful and elegant preparation of iron is 
employed. It is particularly useful in the ancemia of acute and chronic 
parenchymatous nephritis, as it also acts as an efficient diuretic and 
diaphoretic. It is made up as follows : 

Tincture of chloride of iron 2 parts. 

Dilute acetic acid 3 " 

Spirit of Mindererus 20 " 

Elixir of orange 10 " 

Syrup 15 " 

Water 50 " 

The dose is from 1 to 8 drachms (4.0-32.0), well diluted. 

Bromide of Iron. 

Bromide of Iron (Ferri Bromidum) is said by DaCosta to be use- 
ful in ancemia, when this state is associated with chorea, in the dose 
of 5 to 20 grains (0.35-1.3) given in syrup. In other nervous dis- 
eases accompanied by anemia and insomnia the syrup of the bromide 
of iron (Syrupus Ferri Bromidx) is useful in the dose of J to 1 fluid- 
drachm (2.0-4.0), but its sedative properties are not sufficiently marked 
to render it of much value in overcoming true insomnia unless it is 
fortified by one of the other bromides. 

Cacodylate of Iron. 

Under the name of cacodylate of iron a compound has been 
iutroduced which is given in cases of anosmia, in which the hemo- 
globin and the corpuscles are lacking, since by this means we obtain 
the effect of both iron and arsenic. The salt may be given by the 
mouth in the dose of J to 1 grain (0.016-0.06) three times a day, in 
solution, or in urgent cases in the dose of J to J grain (0.008-0.016) 
by the hypodermic needle three times a day. It is asserted by Gilbert 
and Tereboullet that this is not productive of local or renal irritation, 
and in the albuminuria of tuberculosis may even be beneficial. 

Carbonate of Iron. 

The Carbonate of Iron (Ferri Carbonas Saccharatus, U. S. and 
B. P.) is very slightly astringent, and may be used in pill form under 
the aame of Pilulfp Ferri Carbonatis, V. S. (Pilulce Ferri, B. P.), 
sometimes called "Bland's pill," or in Griffith's pill, which also eon- 
tains myrrh. The dose is about 3 grains (0.15). This preparation 
of iron is largely used for the treatment of amenorrhea dependent 
upon anaemia. Under the name of dfistura Ferri Composita, U. S. 
and B. P., or Griffith's mixture, we have a liquid preparation used 
for the same purposes as the pills just named, in the dose of 1 to 2 
tablespoonfuls (15.0-30.0). Massa Ferri Carbonatis, U. &, some- 



IRON. 277 

times called Vallet's mass, is given in Dills in the dose of from 1 to 10 
grains (0.05-0.65). 

Chloride of Iron. 

Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, U. S. ; 
Tinctura Ferri Per chloridi, B. P.), often called Tincture of the 
Muriate of Iron, is one of the best and most useful preparations of 
iron that we have. It is the most diuretic preparation of iron. This 
diuretic effect does not depend upon the presence of a muriatic ether, 
as has heretofore been taught, since it is not present, and is hard to 
prepare except there is an excess of chlorine. According to researches 
of Dr. S. Weir Mitchell, the only ether present is nitrous ether, and 
this is devoid of power and in small quantity. As chloride of iron 
itself is diuretic, it is probably upon this that the diuresis produced 
by it depends. The dose of the chloride of iron [Ferri Chloridum, 
U. S.) is 1 to 3 grains (0.06-0.18). Tincture of the chloride of iron 
is considered a specific in erysipelas, and should be given in very full 
dose and frequently repeated if it is to be of any service. (See Ery- 
sipelas.) 10 minims (0.65), well diluted, every hour are not too much 
if the stomach of the patient does not rebel. In chronic BrigMs 
disease it is of value and decreases the albuminuria. In anozmia it 
is useful, and owing to its acid is a doubly effective tonic. In cases 
of slight anaemia in which very great arterial pressure exists Dr. 
Mitchell uses a purely milk diet, and an ounce of an old tincture of 
iron in the twenty-four hours. While he recognizes the fact that iron 
preparations are generally supposed to raise blood-pressure, he asserts 
that in this instance the blood-pressure is lowered. The dose of 
Liquor Ferri Chloridi, U. S., is 4 to 10 minims (0.2-0.65). It is rarely 
used internally, but chiefly as an astringent of great power. Liquor 
Ferri Chloridi is identical with Liquor Ferri Perchloridi, B. P. 
Tinctura Ferri Per chloridi, B. P., is used internally in the dose of 
10 to 20 minims (0.65-1.3). 

As a local application tincture of the chloride of iron is useful in 
diphtheria and membranous croup, and even in tonsillitis. In each 
of these maladies large doses of the tincture internally, with counter- 
irritation over the neck, are most useful. When used internally it 
should be well diluted with water and taken through a glass tube to 
protect the teeth. The strong solution of perchloride of iron (Liquor 
Ferri Per chloridi Fortis, B. P.) is a powerful styptic. 

Citrates and Tartrates of Iron. 

The four citrates of iron are soluble in water and very useful for 
this reason, because they are readily added to liquid prescriptions, and 
they are also of value because they are very slightly irritant and astrin- 
gent and do not disorder the alimentary canal. Ferri Citras, U. S., 
and Ferri et Ammonii Citras, U. S. and B. P., occur in garnet-red scales 
and are given in the dose of 5 grains (0.35). The solution of the 
citrate of iron (Liquor Ferri Citratis, U. S.) is given in the dose of 



278 DRUGS. 

10 minims (0.65). The Ferri et Quinince Citras, B. P., and the Ferri 
et Strychnince Citras, TJ. S., are usually given in the dose of 5 to 
15 grains (0.35-1.0) and 1 to 3 grains (0^05-0.15), respectively. The 
new official Ferri et Quinince Citras Solubilis, TJ. S., is given in the 
dose of 1 to 2 grains (0.05-0.10). 

Besides these citrates there are three tartrates — (Ferri et Ammonii 
Tartras, TJ. S., and Ferri et Potassii Tartras, TJ. S., and Ferrum Tar- 
tar atum, B. P., all given in the dose of 5 grains (0.35). 



Dialyzed Iron. 

Dialyzed iron (Ferrum Dialysatum) is a very feeble preparation 
of iron, lacking in astringency, easily precipitated from the solution 
in which it occurs, but at one time largely used in ancemia by some 
practitioners. The dose is 10 to 20 minims (0.35-1.3) in water three 
times a day. Sometimes river-water, if it contains much inorganic or 
organic matter, will precipitate it. Owing to the instability of 
dialyzed iron, it may be used without any further preparation as an 
antidote to arsenic. 

Hydrated Sesquioxide of Iron. 

Hydrated Sesquioxide of Iron (Ferri Oxidum Hydratum, TJ. S.) is 
the antidote to arsenic, but to be efficacious it must be freshly prepared. 
It is to be made by precipitating any liquid preparation of iron by 
the addition of an alkali, such as ammonia, or by the addition of mag- 
nesia. The resulting precipitate is the antidote, and the supernatant 
liquid is to be poured off. If ammonia is used, the precipitate must 
be washed with water several times to get rid of the alkali, which will 
render the antidote too irritant to be swallowed if it is allowed to 
remain with the precipitate. Magnesia is an antidote in itself, and 
should be preferred under all circumstances. The antidote should be 
given in excess, and as much as a pint of the iron solution should be 
precipitated. The magnesia should be freely added, as too much of it 
cannot be given. The antidote to arsenic is official as Ferri Oxidum 
Hydratum cum Magnesia, TJ. S. In the Prussian Pharmacopoeia this 
is known as the Antidotum Arsenici. (See Arsenic, Poisoning by, 
for official method of preparing antidote.) 

Iodide of Iron. 

The Syrup of the Iodide of Iron (Syrupus Ferri Iodidi, TJ. S. and 
B. P.) is a transparent liquid of a sweet, iron-like taste. It should 
contain no free iodine, and if a sample of it strikes a blue color with 
starch it should be discarded. It is largely used in ancemia associated 
with scrofulosis and struma, and is useful in the eczema of young 
children when this is dependent upon lack of vitality or anaemia. 
The dose to a child of two years is 2 to 3 minims (0.1-0.15), well 
diluted, and to an adult 30 to 40 minims (2.0-2.65) in water, to be 
taken tli rough a glass tube to protect the teeth. 



IRON. 279 

The saccharated iodide of iron (Ferri Iodidum Saccharatum, U. S.) 
is used in place of the syrup in the dose of 2 to 5 grains (0.1-0.3). 
The official pills (Pilula Ferri Iodidi, U. S.) each contain -^ of a grain 
(0.01) of reduced iron and -J of a grain (0.075) of iodine, and are 
given in the dose of one to three pills. 

Subsulphate of Iron, or Monsel's Salt. 

Monsel's Solution (Liquor Ferri Subsulphatis, U. $., Liquor Ferri 
Persidphatis, B. P.) is sometimes wrongly called the Solution of the 
Persulphate of Iron, and is one of the most powerful styptics or 
haemostatics that we have. It is never to be employed where a 
hemorrhage is to be attacked through the circulation, but only when 
the solution can come in direct contact with the bleeding spot. The 
objection to its use is the hard, black, and dirty clot which it forms 
on coming in contact with blood. In haemoptysis Monsel's solution 
should be used in fine spray consisting of from 10 to 60 minims (0.65- 
4.0) to the ounce of distilled water. In uterine hemorrhage from any 
cause the dilution may be half-and-half, or if the hemorrhage be from 
a polypus or the cervix uteri the pure solution should be used, locally 
applied. In nose-blood Monsel's solution may be employed diluted 
one-half or pure ; but its use is not to be commended, because of the 
hard, black clot which is formed and the uncomfortable sensations and 
pain produced in the nasal chambers. Plugging the nostrils, and if 
need be the posterior nares, with pledgets of cotton is generally suffi- 
ciently efficacious. 

For the intestinal hemorrhage occurring during or after typhoid 
fever Monsel's solution has been given, but ought not to be so 
employed, as it is decomposed in the stomach before it reaches the 
intestine. In its stead Monsel's salt (Ferri Subsulphas) should be 
given in pills of 3 grains (0.15) each, the pills being made hard 
enough to escape into the intestine before the stomach dissolves them. 
One, two, or three pills may be given, and repeated in an hour 
in pressing cases. Hcematemesis due to bleeding in the stomach may 
be treated by 3-minim (0.15) doses of the solution in a little water. 
It should be remembered, however, that the drug is irritating if fre- 
quently repeated. 

In tonsillitis and pharyngitis a most efficient application is pure 
Monsel's solution applied by means of a pledget of cotton or camel's- 
hair brush, or equal parts of the solution and glycerin may be used. 
This application is often as painful as it is efficient, and care must be 
exercised that an excess of the fluid be not present, as it may drop 
down and irritate the larynx. In diphtheria this method of treatment 
is often of great service. 

The antidote to Monsel's solution is common soap. 

Oxalate of Iron. 

Oxalate of Iron (Ferri Oxalas) is given in the dose of 2 to 3 
grains (0.1-0.15). It possesses no advantages peculiar to itself. 



280 DRUGS. 



Phosphates of Iron. 



There are two phosphates of iron — Ferri Phosphas Solubilis, TJ. S., 
or Ferri Phosphas, B. P., and Ferri Pyrophosphas Solubilis, TJ. S. 
Phosphate of iron itself is very insoluble and is rarely used. The of- 
ficial forms are, however, quite soluble, and useful in the dose of 2 to 
5 grains (0.1-0.35). Syrupus Ferri Phosphatis, B. P., is given in 
the dose of 1 fluidrachm (4.0). Phosphate of iron is one of the in- 
gredients of the syrup of iron, quinine, and strychnine {Syrwpus 
Ferri, Quinince et Strychnines Phosphatum, TJ. S. ; Syrupus Ferri 
Phosphatis cum Quinina et Strychnina, B. P.), which is given in 
the dose of 1 fluidrachm (4.0). 

Reduced Iron. 

Quevenne's Iron (Ferrum Beductum, TJ. S., and Ferri Bedactum, 
B. P.) is an iron-gray or reddish powder which is frequently adulterated 
with lampblack. If it is pure, it should burn in sparks when dropped 
into a flame ; but if lampblack is present this will not occur. It should 
also yield no sulphuretted hydrogen on adding sulphuric acid to it. It 
is tasteless, and may be given to children for this reason in pills or 
gum-drops, or placed inside of small chocolate creams, or in the form 
of troches (Trochisci Ferri Bedacti, B. P.), each lozenge containing 
1 grain (0.05) of the reduced iron. It is used solely in ansemia, and 
is one of the least astringent of the iron preparations. 



Lactate of Iron. 

The Lactate of Iron (Ferri Lactas, TJ. S.) is soluble in 48 parts 
of water, and is given in the dose of 5 grains (0.32). It is used for 
the same purposes as the other preparations of iron. Lactate of iron 
is one of the ingredients of Syrupus Hypophosphitum cumFerro, TJ. S. y 
the dose of which is J to 1 fluidrachm (2.0-4.0). 



Sulphate of Iron. 

Sulphate of Iron (Ferri Sulphas, TJ. S. and B. P.) is used inter- 
nally in the dose of 5 grains (0.35) in pill form in chronic diarrhoea 
with anosmia. Externally, in a solution of the strength of 5 to 25 
grains to the ounce (0.35-1.65:32.0), it is used as' an astringent 
lotion. Two other forms of the sulphate are also employed — namely, 
the dried (Ferri, Sulphas Exsiecatus, U. S. and B. P.) and the granu- 
lated {Ferri Sulphas Granulatus,U. S.), each of which is given in the 
dose of :> > grains (0.18). 



Valerianate of Iron. 

Valerianate of Iron (Ferri Valeriana*, TJ. S.) is sometimes used in 
hysteria with anarniia, given in the dose of 1 grain (0.00) or more. It 
possesses a very feeble influence as a nervous sedative. 



JALAP. 281 



"Wines of Iron. 

The Bitter Wine of Iron ( Vinum Ferri Amarum, TJ. S.) is useful 
as a bitter tonic in anosmia in both children and adults, and may be ad- 
vantageously accompanied with cod-liver oil. It is given in a dose of 
1 to 2 fluidrachms (4.0-8.0) or more. This wine is composed of soluble 
citrate of iron and quinine, tincture of sweet orange-peel, syrup, and 
stronger white wine. 

Wine of the Citrate of Iron, or Vinum Ferri Citratis, TJ. S. and 
B. P., is composed of the citrate of iron and ammonium, tincture of 
sweet orange-peel, syrup, and stronger white wine. The dose is identi- 
cal with that of the bitter wine, and it is used for the same purposes. 

The plaster of iron (Fmplastrum Ferri), official in the TJ. S., is 
prepared from the hydrated oxide of iron. 

The following preparation of iron is also official : Liquor Ferri 
Acetatis, TJ. S. and B. P., dose 15 minims to 1 iluidrachm (1.0-4.0). 

Untoward Effects of Iron. — Iron is apt to cause gastric distress and 
frontal headache in persons who are susceptible to its use. Even one 
dose will cause this trouble in some persons. In many instances the 
frontal headache will be found to be due to the constipation which 
has been brought on by the iron, and will be relieved if mild laxa- 
tive or purges are used. The state of the bowels should always be 
inquired into when iron is being used, and laxatives given whenever 
constipation is present and iron is being administered. In rheumatic 
and gouty persons frontal headaches are a common symptom when iron 
is given, and purgatives will not generally give relief. Garrod and 
Haig have shown that iron decreases the elimination of uric acid, and 
they think this may account for the production of headache in the 
case of rheumatic patients under its influence. Sometimes salts of 
iron produce vesical irritation and a constant desire to urinate, causing 
mucus to form in abnormal amount in the bladder. In children its 
use may result in nocturnal incontinence of urine. 



JALAP. 

Jalap (Jalapa, TJ. S. and B. P.) is the tuberous root of Ipomoea 
Jalapa {Ipomoea Purga, B. P.), a native of Mexico. It contains two 
resins, jalapin and convolvulin, neither of which is used in medicine 
by itself, though both of them enter into the Resin of Jalap of the 
tf. S. P. In overdose jalap or its resin causes vomiting and purg- 
ing, with gastro-enteritis. 

Therapeutics. — Jalap is used in medicine as a hydragogue purge to 
relieve dropsy of any origin. It may be used to deplete in cases of 
general plethora with cerebral congestion, and owing to its tasteless- 
ness is a useful active cathartic in children if given in the proper dose 
— namely, 1 to 2 grains (0.05-0.10) in J an ounce (15.0) of syrup of 
rhubarb. Combined with calomel, it is preferred to all other purges 



282 DRUGS. 

by some practitioners, particularly if the liver is torpid. Jalap in large 
doses must be used with caution in persons who are feeble, and it is 
contraindicated in cases suffering from gastric or intestinal irritation. 

Administration. — Jalap may be given in the form of the compound 
powder (Pulvis Jalapce Compositus, U. S. and B. P.), dose 15 to 40 
grains (1.0-2.65), which is composed of 35 parts of jalap and 65 
parts of bitartrate of potassium ; and the resin (Resina Jalapce. 
U. S. and B. P.), dose for an adult 2 to 4 grains (0.1-0.2). Owing 
to the small size of thfc dose of the resin and its lack of taste, this 
preparation is to be preferred for children in the dose of \ to J a 
grain (0.016-0.03). The tincture (Tinctura Jalapce, B. P.) is given 
in the dose of J to 1 fluidrachm (2.0-4.0); the extract (Extraction 
Jalapce, TJ. S. and B. P.) is used in the dose of 5 to 15 grains 
(0.35-1.0). 



JBQUIRITY. 

This is a plant known as Abrus precatorius, the seeds of which 
are poisonous when applied to a wound. An active principle, abrin, 
is composed of paraglobulin and a-phytalbumose, which closely resem- 
ble snake-venom in their action. Jequirity is never used internally 
in medicine in this country. An infusion of the powdered seeds, 
made by adding J a drachm to an ounce (2.0 : 32.0) of water at 140° 
F. may be painted with a brush on the inside of the eyelids in cases 
of chronic granular conjunctivitis, in order to produce an acute diph- 
theritic inflammation which will so change the chronic process present 
as to permit of a cure. If an excessive action is developed, it may 
be controlled by hot compresses made of very dilute solutions of cor- 
rosive sublimate. The solution of the drug undergoes decomposition 
with great rapidity, and should be freshly prepared each time it is used, 
or 4 to 8 grains (0.2-0.5) of boric acid should be added to preserve it. 
The drug is a powerful cardiac depressant poison when injected into the 
circulation. Whether the seeds produce poisoning when swallowed is 
doubtful, some asserting that they cause gastro-enteritis, others that 
they are harmless. Probably much depends on the activity of diges- 
tion and absorption at the time of ingestion. 



JUNIPER. 

Juniperus is the fruit or berry of Juniperus communis, an ever- 
green of Northern Europe and America. It contains a volatile oil 
Miid an amorphous principle, juniperin. 

Physiological Action. — Juniper acts as a gastric stimulant and 
tonic, as a mild diaphoretic if combined witli alcohol, and as a 
marked stimulating, exciting diuretic. It escapes from the body by 
the kidneys. 

Therapeutics.- — Juniper is valuable as a stimulant to the genito- 
urinary tract whenever it is depressed or chronically diseased, as in 



KAMALA— KINO. 283 

chronic pyelitis, nephritis, and chronic catarrh of the bladder. In con- 
gestion of the kidneys, particularly that due to feeble circulation, if 
not accompanied by active renal changes, it relieves these organs and 
does away with albuminuria. Used after an attack of acute Bright 's 
disease when reaction has set in and the secreting epithelium of the 
kidney is atonic, it is of value ; but care should be taken that all in- 
flammation has passed by or it will make the patient worse. In the 
later stages of scarlet fever, in which the renal condition corresponds 
to that just described, juniper is also useful. In old persons a sensa- 
tion of weight across the lumbar region is often quickly removed by 
the use of juniper if the kidneys are inactive. 

Administration. — Juniper is used in the form of the compound 
spirit (Spiritus Juniperi Compositus, U. #.), composed of the oils of 

juniper, caraway, and fennel, combined with alcohol and water, in 
the dose of 1 to 4 drachms (4.0-16.0). Grin is virtually identical 
with the compound spirit. The infusion of juniper is made by adding 
an ounce (30.0) of the berries to a pint (J- a litre) of boiling water and 
allowing it to stand in a warm place for an hour. The entire quantity 
is to be taken in twenty -four hours. This infusion is often combined 
with an ounce (31.0) of acetate of potassium or of the bitartrate of 
potassium in the treatment of dropsy. The spirit (Spiritus Juniperi, 

U. S. and B. P.) is given in the dose of 30 minims to 1 drachm (2.0- 
4.0). The oil {Oleum Juniperi, U. S. and B. P.) is used in the dose 
of 1 to 4 minims (0.06-0.3). 

KAMALA. 

Kamala, U. S., or Rottlera, as it is sometimes called, is the glands 
and hairs from the capsules of Mallotus p>hilippiensis, a plant of 
Abyssinia, India, China, and Australia. It contains an active prin- 
ciple, rottlerin, which is not official. Given in the dose of 1 to 2 
drachms (4.0-8.0), kamala acts as a drastic purge and as a remedy 
for tapeworm, and is sometimes used for the removal of the ascaris 
lumbricoides. It should be administered in syrup in which is placed 
some hyoscyamus to prevent griping, and the dose is to be repeated in 
eight hours if no effect is produced. (See Worms.) 



KAOLIN. 

Kaolin (Kaolinum, B. P.) is a soft white powder, a decomposition- 
product of mineral deposits containing feldspar. It is used externally 
as a dusting powder in eczema. 

KINO. 

Kino (B. P.) is the inspissated juice of the Pterocarpus Marsupium, 
a tall tree of India. It contains kino-tannic acid, and is used as an 
astringent in the treatment of serous diarrhoea. It is official in the 
form of the tincture {Tinctura Kino, U. S. and B. P.), and is given 
in the dose of 1 fluidrachm (4.0). Kino may be used as a gargle in 



'284: DRUGS. 

sore throat and for relaxation of the uvula. Under the name of Com- 
pound Powder of Kino (Pulvis Kino Compositus, B. P.) an efficient 
and pleasant cintidiarrhoea powder is used. This powder is not official 
in the L. S. P. The formula for each powder is 15 grains (1.0) of 
powdered kino, 4 (0.2) of powdered cinnamon, and 1 (0.05) of pow- 
dered opium. 

KOLA. 

This drug is the nut of Kola acuminata, a tree growing in certain 
parts of Africa. The nut depends for its chief medicinal activity 
upon the caffeine which it contains. In addition to this alkaloid it 
contains some theobromine and kolatannic acid, which latter ingredi- 
ent may explain the good results which have followed the use of kola 
in cases of diarrhoea. 

Physiological Action. — The physiological action of kola is, as far as 
we know, nearly identical with its near relatives coffee and coca. 

Therapeutics. — In cases of feeble heart associated Avith general debil- 
ity kola often proves a valuable stimulant to the heart and general sys- 
tem, as well as to the kidneys. It has also been used with asserted 
success in seasickness and to sober drunken persons, although the 
latter power is to be doubted. Its use will sometimes relieve sick 
and neuralgic headache. Recently a large number of semi-proprietary 
articles have been introduced to the laity with the statement that they 
increase muscular strength. Except for their temporary stimulating 
power they are useless for this purpose. The drug is, however, of 
value in cases of uterine inertia during labor in the dose of 30 minims 
to 2 drachms (2.0-8.0) of the fluid extract. 

Administration. — Kola is not official. It may be given in the form 
of the fluid extract [Extractum KoIob Fluidum), dose 10 to 30 
minims (0.65-2.0), or in an elixir. A very useful preparation, known 
as the Compound Elixir of Kola [Elixir Kola? Composita), contains 
kola, coca, and guarana, and may be given in the dose of 2 drachms 
(8.0). This forms a useful tonic in some cases of debility, particularly 
if arsenic is added to it. Thus : 

R. — Liq. potassii arsenitis . . • TT l,xvj (10). 

Elix. kolae compositat f^iv. (120.0). 

S. — Dessertspoonful (8.0) after meals. 

LANOLIN. 

Lanolin, w r hich is practically the Adeps Lance Hydrosus of the 
U. S. and B. P., is a fat derived from the wool of the common sheep, 
and is a whitish substance of peculiar stability, very difficult of 
saponification, and incapable of becoming rancid. Unna states that 
ointments of acids, hydrogen peroxide, and other substances may be 
made by it. One great objection to lanolin is its stickiness, which is 
avoided by adding one-third of vaseline. Lanolin is supposed to 
possess wvy remarkable penetrating powers when applied to the skin 
in cases where much infiltration is present, particularly if it is com- 



LEAD. 285 

bined with, resorcin or some similar medicament. In itself it has 
little curative power, and is but little better than lard, suet, or any 
common fat as a basis for ointments. In some cases, which are rare, 
it will cause irritation of the skin. 



LEAD. 

Plumbum, or Lead, is a metal possessing more or less power over 
the organism according to the salts which are employed. It is not 
official as lead itself. 

Physiological Action. — Lead, in one of its soluble salts, if applied 
to a mucous membrane, by reason of its astringent effect, produces a 
blanching which is particularly noticeable where the redness of inflam- 
mation has previously been present. It has little effect when given in 
a single dose, except by an indirect influence over the circulation, 
nervous system, or respiration. (For a description of the effects of 
lead in overdoses see "Poisoning," below.) 

The most irritant and poisonous of the soluble salts is the nitrate, 
the next the subacetate, and the least poisonous of the soluble salts is 
the acetate. 

The insoluble salts rarely cause acute poisoning, but frequently 
produce chronic plumbism. s 

Acute Poisoning. — When the acetate of lead is taken in poisonous 
amounts, it produces a sweet metallic taste in the mouth, followed by 
pain in the epigastrium and the vomiting of white, milky-looking 
liquids or white curds mixed with food. The white color is due to the 
presence of chloride of lead formed by the acid of the gastric juice. 

The pain rapidly increases in severity, and diarrhoea due to gastro- 
enteritis may be set up, or, in other cases, obstinate constipation is 
present. The passages are generally black, this color being due to the 
presence of the sulphide of lead. At the same time the pulse becomes 
rapid, tense, and cord-like, but after a time weak and compressible. 
The face is anxious and pale or livid. The thirst is excessive, and 
cramps in the calves of the legs or muscular twitchings may ensue. It 
is said that the characteristic blue line on the gums may occur in acute 
poisoning, but this is rarely if ever seen. If coma comes on in the 
course of acute lead poisoning, death is almost certain. 

The treatment consists in the use of the chemical antidote, a sol- 
uble sulphate, in large quantity, in the administration of emetics, and 
the use of the stomach-pump if the vomiting produced by the drug is 
not sufficient to rid the stomach of all the poison. The best soluble 
sulphates to employ are Epsom and Glauber salts, because they are 
always at hand, are readily soluble, and, in excess, act as purges 
which will wash out the intestinal canal. Hot applications should be 
applied to the belly and feet, and the pain and irritation which are 
present should be relieved by opium. 

Chronic Poisoning. — Chronic lead poisoning is rarely produced by 
the soluble salts of lead, nearly always being due to the insoluble salts. 
The symptoms of chronic lead poisoning, or plumbism, are as various as 



286 DRUGS. 

it is possible to find variety in the signs of disease of every kind. There 
is no train of symptoms which may not occur, and the occurrence of 
rare, anomalous symptoms in a given case should at once bring to 
the mind of the physician the thought of lead poisoning or syphilis. 
Chronic poisoning occurs in painters, manufacturers of lead salts, and 
every one who is largely thrown in contact with the metal in the arts. 
It occurs from the use of hair-dyes containing the acetate of lead, 
from drinking water which has passed through new lead pipe, and 
even from the biting of silk threads loaded with lead to increase their 
weight. Chromate of lead has been used to color sponge-cake when 
eggs were thought too dear, and has killed many persons. Millers 
who have filled the holes in grindstones with lead have caused wide- 
spread epidemics of what has been called " dry cholera," and many 
persons have suffered from lead poisoning from eating apple-butter 
kept in jars glazed with lead. 

One of the most prominent, but by no means the most constant, 
symptoms of chronic plumbism is bilateral wrist-drop, due to palsy 
of the extensor muscles of the forearm. The short extensor of the 
thumb generally escapes the drug's influence, as does also the supi- 
nator longus. Sometimes internal squint arises from paralysis of the 
external rectus muscles by the lead. Another very common symptom 
is colic centering around the umbilicus and radiating through the belly 
and loins. Obstinate constipation often accompanies these symptoms, 
and the faeces, when passed, are white and clay-colored, owing to a 
deficient secretion of bile. 

During an attack of lead colic the arterial tension is increased very 
markedly, the tongue is coated and whitish, and the bowels are obsti- 
nately confined. 

If these early warnings are disregarded and the exposure to the 
lead is continued, cerebral symptoms may come on, the result of 
encephalopathia saturnina, or saturnine cerebritis. Saturnine epi- 
lepsy is not very rare. If convulsions come on, death generally 
ensues. The convulsions in some cases are not due to a cerebral 
effect of the lead, but to uraemia due to the renal changes which it 
has caused. 

Renal disease is very commonly produced by lead, and it is not 
uncommon for chronic contracted kidney to be found at the autopsy 
of a sufferer from chronic lead poisoning. If a patient with chronic 
lead poisoning have a urine with a persistent low specific gravity, the 
prognosis is grave, as evidencing advanced kidney involvement. 

Asthma due to the inhalation of lead-dust is sometimes met with. 

The most important confirmatory evidence of chronic lead poisoning 
is a blue line on the gums just where they join the teeth. Its absence is 
not a negative sign, however, as poisoned persons cleanly in respect to 
their mouths often do not have it. Marked cachexia or anaemia is 
commonly seen in chronic lead poisoning. 

After prolonged lead-poisoning the nerve-trunks are found atro- 
phied, and finally changed into fibrous cords. Anterior poliomyelitis 
may be present, but true locomotor ataxia is rarely caused. If ataxic 
symptoms exist, they are most probably dependent on pseudo-tabes 



LEAD. 287 

produced by a plumbic multiple neuritis, and can be separated from 
true tabes dorsalis by the absence of several of the important true 
tabetic symptoms — such as slow onset, the Argyll-Robertson pupil, etc. 
— while the presence of marked wasting and loss of power, and some- 
times tenderness over the nerve-trunks, points to neuritis. 

In some cases trophic changes in the joints ensue, and plumbic 
gout is not rarely seen, or even lead arthralgia, with deposits of urates 
in the joints. This condition is due to the fact, pointed out by Gar- 
rod and Haig, that lead forms insoluble salts with uric acid. 

Lead escapes from the body in the urine, the faeces, and all the 
secretions. It is chiefly eliminated by the liver in the bile. 

Treatment of Chronic Poisoning. — The treatment consists in 
three classes of remedial measures : 1st, the removal of the cause ; 
2d, the removal of the poison in the body; and, 3d, the treatment of 
the lesions produced by the poison. 

In lead colic hepatic purges, such as jalap and calomel, combined 
with opium to prevent pain, are indicated, and alum and opium or 
morphine are said to be almost specifics, the alum in 2-grain doses, 
the others in full amounts. In many cases purges fail to move the 
bowels of a person suffering from chronic lead poisoning, and succeed 
only when morphine is given to overcome the intestinal inhibition 
produced by the irritation caused by the lead. 

In the cerebral inflammation of lead-poisoning a blister to the back 
of the neck, revulsives, and a pilocarpine sweat may be resorted to. 

To aid in the elimination of the lead, iodide of potassium, which 
forms double soluble salts in the tissues with the metal, is to be used, 
10 to 20 grains (0.65-1.3) three times a day. 

If progressive paralysis is present, Wood insists on the use of 
large doses of strychnine at the same time that the iodide is given. 
The strychnine should not, of course, be given in the same mixture as 
the iodide, as it is incompatible. 

Electricity should be used as a remedy to restore lost function. If 
the faradic current makes the muscles contract, it should be employed, 
and, if not, the galvanic current should be used. Curiously enough, 
partial voluntary power sometimes returns before the muscles will react 
at all to electricity. 

It is said that baths of sulphuret of potassium do good in chronic 
plumbism, 5 or 6 ounces (160.0) of the salt to each bath, which is to be 
given in a wooden tub. The patient should afterwards be well soaped, 
then thoroughly rinsed off, and rubbed down with a rough towel. 

As the salts of lead are used for different purposes, the therapeu- 
tics of each one will be taken up separately. 

Acetate of Lead. 

Acetate of Lead (Plumbi Acetas, TJ. S. and B. P.), or Sugar of 
Lead, has a sweet, astringent taste, and is soluble in water, although 
the solution formed is slightly milky in appearance. 

Therapeutics. — Acetate of lead may be used, and is largely 
employed, in the following pill in the treatment of serous diarrhoea : 



288 DRUGS. 

R .— Plumbi acetat gr. xl (2.65). 

Pulv. opii gr. x (0.65). 

Camphor* gr. xl (2.65). — M. 

Ft. in pil. No. xx. 
S. — One every four hours. 

This pill maj'' also be given in cases of dysentery. 

The acetate of lead in proportion of 1-8 grains (0.06-0.5) to the 
ounce of water may be used as an injection for gonorrhoea. 

Lead acetate is also a useful application for the dermatitis produced 
by poison ivy, as this drug precipitates the sticky, non-volatile oil of 
Rhus toxicodendron, recently studied by Pfaif. The acetate of lead 
should be dissolved in alcohol in the proportion of half a grain to the 
ounce (0.03-30.0) and used as a wash. After this the inflamed parts 
should be treated by cooling applications, but ointments are not to be 
used, as they dissolve the poisonous oil and spread the irritation. 

Administration. — The B. P. recognizes the following preparations 
of lead acetate: Pilula Plumbi cum Opio, dose 3 to 5 grains (0.1- 
0.3); Suppositoria Plumbi Oomposita, each suppository containing 1 
grain (0.06) of opium to 3 grains (0.18) of lead acetate; and an oint- 
ment ( Unguentum Plumbi Acetatis). 

Carbonate of Lead. 

Carbonate of Lead {Plumbi Qarbonas, U. S. and B. P.), or White 
Lead, is insoluble, and is used as a coating or dressing for burns, 
scalds, or ulcers when rubbed up with linseed or other oil, or in the 
form of the ointment (Unguentum Plumbi Carbonatis, IT. S. and 
B. P.). If a wide surface is covered with this ointment, it may 
cause lead poisoning by absorption. 

Carbonate of lead may be used in the treatment of sunburn in the 
following prescription : 

R.— Plumbi carbonat £j (4.0). 

Pulv. amyli £j (4.0). 

Unguent, aquae rosfe %] (32.0). 

Olei olivse . . . fjij (8.0).— M. 

S. — Apply to the inflamed skin. 

Iodide of Lead. 

Iodide of Lead (Plumbi Iodidum, U. S. and B. P.) is occasion- 
ally employed in medicine; the dose is J to 2 grains (0.03-0.1). 
Emplastrum Plumbi Iodidi, B. P., and Unguentum Plumbi Iodidi, 
U. S. and B. P., are used as external astringent and alterative appli- 
cations, but are rarely useful. 

Liquor Plumbi Subacetatis. 

Liquor Plumbi Subacetatis, U. S., and Liquor Plumbi Sub- 
acetatis Fortis, B. P., or Goulard's Extract, is a colorless liquid, 
much used externally, when diluted with laudanum, for sprains, 
bruises, and local inflammations, under the name of " lead-water and 



LEPTANDRA. 289 

laudanum." "L. and L.," as it is often called in the hospitals, is a 
useful application in the dermatitis produced by poison ivy. The 
proportion should be 4 parts of the undiluted lead-water, diluted with 
16 parts of water, to 1 of laudanum, but this is varied as the inflam- 
mation or pain is the more severe. The official liquor is also official 
in a dilute solution (Liquor Plumbi Subacetatis Dilutus, TJ. S. and 
B. P.), and as such is too weak for ordinary use, although it is com- 
monly employed. The strong solution should be used in the strength 
of from 1 to 4 ounces (30.0-120.0) to the pint (500 cc.) of water. 
This solution should never be employed if the skin is broken, as 
absorption may occur, and, what is more important still, the drug pre- 
vents healing by constringing and whitening the edges of the wound. 

If some bread-crumbs be saturated with the solution just named 
and applied to an inflamed finger, a felon can often be aborted in the 
early stages. The official dilute solution is useful as a lotion in eczema 
which itches and tingles and is not dry in character. It should be 
applied once or twice a day, and it is well to follow the application of 
lead with a weak sulphur bath or alkaline wash. (See Eczema.) 

Lead-water is also useful in pruritus pudendi. The cerate (Cera- 
tum Plumbi Subacetatis, TJ. S.), the liniment (Linimentum Plumbi 
Subacetatis), and the glycerin (Grlycerinum Plumbi Subacetatis, B. P.) 
may be used for the same purposes as the Goulard's extract. 

Litharge. 

Litharge (Plumbi Oxidum, TJ. S. and B. P.) is used for the prep- 
aration of lead plaster (Emplastrum Plumbi, TJ. S. and B. P.), some- 
times called " Diachylon," and this is in turn employed for the manu- 
facture of resin plaster (Emplastrum Besinoz, TJ. S. and B. P.). It 
is also used in the preparation of the solution of subacetate of lead. 

Hebra recommended for sweating of the feet an application of equal 
parts of lead plaster and linseed oil, applied on linen and wrapped 
around the feet every third day. 

Nitrate of Lead. 

Nitrate of Lead (Plumbi Nitras, TJ. S.) is never used internally, 
but as a powder, in the treatment of cases of onychia maligna and in 
the formation of Ledoyen's disinfecting solution. The latter dis- 
colors the paint in water-closets, dissolves the solder in drain-pipes, 
and is not a good preparation for general use. 



LBPTANDRA. 

The medicinal portion of Veronica virginica is the rhizome and 
rootlet, from which are made the official extract of leptandra (Extrac- 
tum Leptandrce, TJ. S.) and the fluid extract (Extr actum Leptandroe 
Fluidum, TJ. S.). The dose of the former is from 1 to 8 grains 
(0.06-0.5) and of the fluid extract 5 to 40 minims (0.3-2.6). 

19 



290 DRUGS. 

Physiological Action. — Very few experiments have been made as 
to the action of this remedy, and the only ones of importance are 
those of Rutherford and Vignal, who found that it possesses a mod- 
erate influence in increasing the flow of bile. In overdose it causes 
violent purging. 

Therapeutics. — In the official preparations of leptandra, which are 
not as active as is the fresh drug, we have excellent substitutes for 
calomel, according to many clinicians. Those who have used leptan- 
dra also believe it to be of the greatest value in the indigestion of the 
intestinal type sometimes called " duodenal atony." (See also Podo- 
phyllin.) The following pill is a good method of using the drug in 
these cases : 

R.— Ext. chiratae gr: xx (1.3). 

Ext. leptandrae . . gr. xx (1.3). — M. 

Ft. in pil. No. x. 

S. — One pill after each meal. 

Under the name of leptandrin we have an impure resin which is 
given in the dose of 2 to 5 grains (0.1-0.3). An alkaloid of doubtful 
existence is called leptandrine. 



LEVULOSB. 

Levulose is a monosaccaride sweeter than cane-sugar, and if pure 
free from glucose. It is used in medicine as a substitute for sugar in 
the dietetic treatment of diabetes, and is absorbed as levulose and then 
completely oxidized in the body. Levulose may be taken by diabetic 
patients in the dose of 1 to 2 ounces a day without injury in many 
instances, and tends to promote nutrition. One firm places it on the 
market under the name of " Diabetin." 

LIPANIN. 

Lipanin is an artificially prepared mixture devised by von Mering 
as a substitute for cod-liver oil, and consists in 6 parts of oleic acid 
added to 100 parts of olive oil. The advantages possessed by it are 
its lack of disagreeable odor and taste and its ready emulsification 
and digestibility. The commencing dose is 1 drachm (4.0) which 
may be increased to 4 drachms (16.0). This mixture has been found 
of value in most of the wasting diseases in which cod-liver oil is em- 
ployed, and in the opinion of von Mering its efficacy is greatly increased 
if the hvpophosphites of lime and sodium are used at the same time in 
the dose of 10 grains (0.65) three times a day. Iodine or one of its 
compounds may also be given if it is desired to exert an alterative 
influence. 

LIQUORICE. 

Liquorice (Glycyrrhiza, U. S., and Q-lycyrrhizce Radix, B. P.) is 
the rool of* Qlycyrrhiza (jlabra, a plant of Southern Europe and Asia. 



LIQUOR POTASS^-LITHITJM. 291 

It is used to increase secretion in the mouth in the form of a solid 
extract, and when dissolved in water to form a vehicle for other drugs, 
particularly if they have a disagreeable taste. The powdered solid 
extract is a very mild and useful laxative. 

Administration. — The solid extract {Extraction Grlycyrrhizce, TJ. S. 
and B. P.) is used in a dose anywdiere from 5 to 120 grains (0.35— 
8.0). The pure extract {Extractum Crlycyrrhizce Purum, TJ. S.) is 
used in the same quantities as the ordinary extract. The fluid extract 
{Extractum G-lycyrrhizce Fluidum, TJ. S.) or the liquid extract {Extrac- 
tum G-lycyrrhizce Liquidum, B. P.) is used in 1- to 2-drachm (4.0-8.0) 
doses. Under the name of Brown Mixture or " Compound Liquorice 
Mixture " a very efficient expectorant solution is official {Mistier a 
Glycyrrhizce Composita, TJ. $.), which contains as its most important 
ingredients 12 parts of paregoric, 6 parts of wine of antimony, and 
3 parts of sweet spirit of nitre. The dose of Brown Mixture is 1 to 4 
drachms (4.0-16.0). Pulvis Glycyrrhiza 3 Compositus, TJ. S. and B. 
P., or compound licorice powder, contains, according to the TJ. S. P., 
18 per cent, of senna, 23.6 per cent, of liquorice, 4 per cent, of oil of 
fennel, 8 per cent, of washed sulphur, and 50 per cent, of sugar. Ac- 
cording to the B. P., it should contain 2 parts of senna, 2 of liquorice- 
root, 1 of fennel-fruit, 1 of sublimed sulphur, and of sugar 6 parts. 
The dose is 1 to 4 drachms (4.0-16.0). It is largely used as an 
efficient laxative after childbirth and in cases which suffer from 
constipation chiefly due to the inactivity consequent upon being 
in bed. The troches {Trocliisci Glycyrrldza? et Opii,TJ. $.) contain 
-£q grain (0.003) of opium and 2 grains (0.1) of extract of liquorice. 
Finally we have Glycyrrhizinum Ammoniatum, TJ. S., which is the 
sweet principle of -liquorice rendered soluble and easily tasted by the 
addition of ammonia. The dose of this preparation is 5 to 15 grains 
(0.3-1.0). 



LIQUOR POTASSES. 

Liquor Potassa>, TJ. S. and B. P., is a solution of potassa contain- 
ing about 5 per cent, of potassium hydrate, and is a clear, odorless 
liquid of caustic taste and strongly alkaline reaction. It is used in 
medicine as an antacid and for the purpose of decreasing the acidity 
of the urine. 

In cases of ingroiving toe-nail it is often used to soften the nail 
prior to packing with cotton or partial evulsion. Its dose is 5 to 30 
minims (0.35-2.0) well diluted with water. 

LITHIUM. 

Lithium is used in several forms, but its salts may be divided into 
two classes — those which act as lithium and those which act as the 
acids forming them. In the first class we have the carbonate {Lithii 
Carbonas, TJ. S. and B. P.), dose 2 to 10 grains (0.1-0.65), the citrate 
{Lithii Citras, TJ. S. and B. P.), dose 5 to 20 grains (0.3-1.3), and 



292 DRUGS. 

the effervescent citrate (Lithii Citras Effervescens, U. S. and B. P.), 
dose 1 to 4 drachms (4.0-16.0). In the second class we find the 
benzoate (Lithii Benzoas, U. &), dose 5 to 80 grains (0.3-2.0); 
Lithii Bromidum. U. S., dose 10 to 40 grains (0.65-2.65), and 
Lithii Salicylas, U. S., dose 10 to 30 grains (0.65-2.0). 

The carbonate and citrate are used in gout and rheumatoid arthritis 
for the purpose of entering into combination with the uric acid in the 
body to form soluble urates and prevent deposits in the joints. They 
have been said to dissolve calculi, but this is untrue, though they 
are used when it is desired to render the urine alkaline. Haig has 
pointed out that although lithia forms salts with uric acid in the 
test-tube, in the body it has a greater affinity for the acid sodium phos- 
phate in the blood, and practically leaves the uric acid to itself. 
This is an important point, since it proves that the large- amount of 
water generally taken with lithia has more to do with relieving 
gout than has the lithia. The carbonate is not soluble in water, 
and should be given in capsule or freshly-made pill, but the citrate is 
soluble. The latter may be made from the former by taking 50 grains 
(3.3) of the carbonate, 90 grains (6.0) of crystallized citric acid, and 
warm distilled water 1 fluidounce (30.0). The acid should be dissolved 
first, and the carbonate added to the solution. The solution should 
then be kept hot until effervescence ceases. 

In cases of diabetes depending upon a gouty taint remarkable 
results are said to be obtained from the use of the citrate or carbonate 
of lithium and arsenic. The dose should be -^ of a grain (0.002) of 
arsenite of sodium and 10 grains (0.65) of the lithium salt three times 
a day. 

It is worthy of note that in some cases citrate of lithium will dis- 
order the stomach and produce vomiting ; and overdoses produce gen- 
eral relaxation of the system with a sense of feebleness. 

(For the use of other salts of lithium see the articles on the Bro- 
mides, Salicylic Acid, and Benzoic Acid.) 

(See also article on Mineral Springs.) 

LOBELIA. 

Lobelia, U. S. and B. P., is the leaves and tops of Lobelia inflata, 
a common weed of the United States. It contains an alkaloid, lobe- 
line, and lobelic acid. 

Physiological Action. — When taken in overdose lobelia causes erne- 
sis, intense prostration, a feeble pulse, pale skin, livid face, muscular 
relaxation, and a cold sweat. Violent purging may be present. It 
is said to paralyze the motor nerve-trunks, and it causes a fall of 
arterial pressure, followed by a rise, the latter change being due to 
the asphyxia which it finally produces. Ultimately it paralyzes the 
respiratory centre and the peripheral vagi. The treatment of the 
poisoning is to administer opium to stop irritation and vomiting, 
to give alcohol and ammonia to support the heart, and the use of 
external heat. 

Therapeutics. — Lobelia is used chiefly as an antiasthmatic, and has 



LYCETOL—LYSOL. 293 

been equally praised and condemned by eminent authorities. The 
reason for this lies in the fact that it is generally useless in asthma 
unless given in almost poisonous dose. Wood teaches that it should 
rarely if ever be used, because of its poisonous effects even in doses 
medicinally active, while Sydney Ringer says that the drug is erro- 
neously thought to be dangerous. In asthma both of the gastric and 
bronchial form lobelia is undoubtedly of service. In some cases it 
fails as signally as it succeeds in others. If the asthma is due to or 
associated with cardiac disease, lobelia should never be employed. 
The dr ig should be taken in the dose of -J- a drachm (2.0) to 1 drachm 
(4.0) of the tincture at the first sign of an attack, or in 10-minim (0.65) 
doses every fifteen minutes until distinct nausea occurs or relief is 
obtained. If the heart is feeble, its use is contrainclicated. 

In atonic constipation with great dryness of the faeces 10 minims 
(0.65) of the tincture of lobelia at bedtime are often of service, 
particularly if it is combined with cascara sagrada. (See Cascara 
Sagrada.) 

Administration. — Lobelia is given in the form of the tincture [Tinc- 
tura Lobelias, U. #.), in the dose of 10 to 30 minims (0.65-2.0), or 1 
to 2 drachms (4.0-8.0) as an emetic. The vinegar (Acetum Lobelice) 
is no longer official, but is given in the dose of 20 to 30 minims (1.65- 
2.0), and the fluid extract (Lxtr actum Lobelias Fluidum, U. S.) in 
the dose of 1 to 5 minims (0.05-0.35), or as an emetic in the dose of 
15 minims (1.0). 

In the form of the infusion lobelia is useful as a lotion in the treat- 
ment of the dermatitis produced by poison ivy. The proportion used 
should be an ounce (31.0) to the pint (^ litre) of water. 

The preparation of the B. P. is Tinctura Lobelias JEtherea, dose 
10 to 30 minims (0.65-2.0). 

LYCETOL. 
(See PlPERAZINE.) 

LYCOPODIUM. 

Lycopodium, U. S., is a pale-yellow powder derived from Lyco- 
podium clavatum, a species of moss. It is used by pharmacists as a 
powder in which to roll pills, and by physicians and nurses to prevent 
the intertrigo or chapping of the shin of infants and adults. 



LYSOL. 

This is a preparation made by dissolving in fat and saponifying 
with alcohol that part of tar oil which boils between 190° and 200° 
C, and is a brownish, clear, oily fluid, smelling somewhat like creo- 
sote. It is used for the same antiseptic purposes as creolin (see Creo- 
lin), but possesses the advantage of forming a clear, soapy fluid when 
mixed with water, in which instruments can be seen. If small instru- 
ments are used, the solution is so soapy that it renders them too slippery 



294 DRUGS. 

for ready use. Those who have used lysol claim that it does not affect 
the skin of the operator's hands except to render it soft and flexible. 
Experiment shows it to be possessed of marked antiseptic power, and 
it is far less poisonous than carbolic acid. Used upon mucous mem- 
branes, a solution of lysol should not be stronger than 2 per cent. 

MAGNESIA. 

Magnesia is the oxide of magnesium, made by exposing the car- 
bonate of magnesium to a red heat. It is used in the form of the 
light magnesia {Magnesia Levis, B. P.) as a dusting-powder. The 
troches {Trochisci Magnesia?) each contain 3 grains (0.015). Mag- 
nesia Ponderosa is official in the B. P. 

Magnesia is an antidote to arsenic, and when employed to precip- 
itate a soluble preparation of iron it forms the Antidotum Arsenici 
{Ferri Oxidum Hydratum cum Magnesia, U. S.). 

It is important that the student should not confuse magnesia and 
magnesium. The first is the oxide of the second, and is sometimes 
called calcined magnesia or "Husband's Magnesia." Magnesia is of 
little value in internal medicine except as a feeble antacid. Magnesia 
and the carbonate of magnesium may be used interchangeably. 

MAGNESIUM. 

Magnesium is a metal never used as such, but always in the form 
of one of its salts, which are the sulphate, citrate, carbonate, and 
sulphite. The sulphite is a natural salt found in sea-water and in 
caves or in the water coming from the latter. The citrate and car- 
bonate are derived from the sulphate. The carbonate is insoluble in 
water and alcohol. The others are soluble. 

Magnesium Carbonate. 

The Carbonate of Magnesium {Magnesii Carbonas, U. S.) is official 
in the form of the heavy and light powder {Magnesii Carbonas Pon- 
derosus and Levis, B. P.), and these two substances do not differ in 
respect to their effects. The light magnesium is never given internally, 
because of its bulk, but it is used as a dusting powder in intertrigo, 
and in the form of white cubes rubbed on the skin to prevent ex- 
cessive perspiration and as a cosmetic. The heavy magnesium is 
used as an antacid, and is not, as has been thought by some, in 
any souse a laxative, as it possesses no such power. When the stom- 
ach or intestines contain much acid from fermentative changes, these 
acids may. however, unite with the magnesium and form a slightly 
laxative salt. 

In siek headaches due to great gastric acidity carbonate of magne- 
sium is often of service. The dose of the carbonate is from 5 to 60 
grains (0.3-4.0) It should not be used constantly, as there is danger 
thai it will accumulate in the intestines. 

Liquor Magnesii ( 1 <irl><>ii<iti><* B. P., is given in the dose of 1 to 
'1 ounces (30.0-60.0) as a laxative. 



MAGNESIUM. 295 

Magnesium Citrate. 

The Citrate of Magnesium (Magnesii Citras) is a much more irri- 
tating purge than the sulphate, but it is more agreeable to the taste. 
It is official in two forms, one of which is the solution (Liquor Mag- 
nesii Oitratis, U. S.\ which is effervescent and should never be used 
unless freshly prepared. It is made by adding bicarbonate of potas- 
sium to a syrupy solution of the citrate of magnesium containing an 
excess of acid, and corking the bottle tightly, the cork being tied 
down with a strong cord. Care should be taken that the bottle is a 
strong one, as the development of large amounts of carbonic acid gas 
may burst it if it be weak. The dose is half to one bottle, which 
contains about 12 ounces (360 cc). It is too irritating to be used 
where inflammation of the alimentary canal exists, but is useful in 
the treatment of sick and bilious headache. 

The Granulated Citrate {Magnesii Citras JEffervescens, U. S.) is 
less agreeable to take than the solution just named. It should be 
dissolved in water, about 1 to 3 drachms (15.0-45.0) of the salt being 
used in each dose, and sw r allowed while the solution is effervescing. It 
must be kept in bottles tightly corked. 

Magnesium Sulphate. 

Sulphate of Magnesium {Magnesii Sulphas, U. S. and B. P.) is a 
white granular powder of neutral reaction and salty taste, and is sol- 
uble in water. It is "generally known as "salts," although in some 
parts of the country this term also includes the sulphate of sodium and 
" Rochelle salts." 

According to the studies of Hay and others, sulphate ol magnesium 
is a purge by reason of its abstraction of water from the intestinal 
blood-vessels. All strong saline solutions above the strength of 7 
per 1000 abstract liquids from the tissues when brought in contact 
with them. The recollection of these facts readily makes clear the 
mode of action of magnesium sulphate. "Whenever a thorough pur- 
gative action is required — that is, where depletion of the intestine or 
absorption of exudations is to be attained — the magnesium should be 
given in concentrated form, so as to make its solution as of high a 
percentage as possible. 

Magnesium sulphate may be given by enema with the double 
purpose of unloading the. bowels and acting as a depletant. The 
best mixture for this purpose seems to be that of Watkins — namely, 
2 ounces (64.0) of magnesium, 1 ounce (32.0) of glycerin, and 4 
ounces (128.0) of water. 

In cases of dropsy the use of concentrated solutions is particularly 
necessary if free watery evacuations are desired, and from 1 to 2 
ounces should be given before breakfast or on an empty stomach in as 
little water as will dissolve the salt. (See Dropsy.) Generally it is 
better to give this quantity divided into small doses every fifteen 
minutes till it is all taken. 

In enteritis and peritonitis the use of magnesium is widely recog- 
nized as a proper measure for its depletant effects, and it is claimed 



296 DRUGS. 

to be better than ipecac in the treatment of tropical dysentery. 
When used for the latter purpose it should be given in drachm (4.0) 
doses of a saturated solution with 10 to 15 drops (0.65-1.0) of aromatic 
sulphuric acid every two hours. The sulphate is not irritating, and 
may be given freely when inflammation exists. (See Peritonitis.) 

It forms a large part of most of the natural purgative waters. 

Sometimes severe attacks of renal pain will occur in middle-aged 
persons who have frequent attacks of gravel, and the urine will be 
found to contain octahedral crystals of calcium oxalate. A useful 
treatment is to give \ to 1 drachm (2.0-4.0) of magnesium sulphate 
with equal parts of citrate of potassium twice or thrice a day, in water, 
for a considerable period of time. 

The B. P. contains an official preparation called Magnesii Sulphas 
Effervescens, which is granulated, and is given in the dose of 4 to 8 
drachms (16.0-30.0). 

MAMMARY GLAND. 

The extract of mammary gland of the common sheep has recently 
come into general use in the treatment of cases of subinvolution of the 
uterus and for the purpose of arresting metrorrhagia or other forms 
of loss of blood from the uterus. It seems to exercise a good effect 
upon the bleeding and growth of many uterine fibroids, but cannot, of 
course, cure the condition. The dose of extract of mammary gland is 
5 grains three times a day, or, if hemorrhage is free, as much as 6 doses 
a day may be used. Overdoses cause cardiac palpitation, but moder- 
ate doses seem to favorably affect general nutrition. Bleeding from 
soft fibroids is not so favorably affected by its use as that from hard 
fibroids. 

MANGANESE. 

Manganum, or Manganese, is official in the U. S. Pharmacopoeia 
in the form of the black oxide [Mangani Dioxidum) and the sul- 
phate (Mangani Sulphas). The first of these, under the name 
binoxide of manganese, has been highly praised in amenorrhoea 
dependent upon functional disturbance and anremia. The dose is 3 
to 5 grains (0.15-0.3) three times a day, in pill form, and the drug 
should be taken for a few days before the expected or proper date for 
menstruation. The sulphate is rarely if ever employed, but may be 
tried in malarial jaundice. The dose is 1 to 2 grains (0.05-0.1) . 

MANNA. 

Manna, U. #., is the concrete saccharine exudation of Fraxinus 
Ornus, a tree of Europe. It occurs in roundish masses of varying 
size, looking somewhat like a gray-colored gum arabic. It has a 
sweet taste and odor. Sometimes the taste is a little bitter. 

Therapeutics. — Manna is the most feeble of the laxatives, and 
causes a, slight flatulence in some persons. In children fed by the 
bottle one of the most frequent disorders is obstinate constipation, and 



MA TRICARIA—MERCUR Y. 297 

for its relief 1 to 2 drachms (4.0-8.0) of the sweet variety of manna 
may be dissolved in the milk of each bottle. When given to older 
children or adults, manna is always combined with other more power- 
ful drugs, chiefly to cover their taste. It may be combined with 
advantage with rhubarb and senna, and it enters into the official 
Infusum Sennce Compositum, U. S., the dose of which is from 1 to 4 
fluidounces (30.0-120.0). 

MATRICARIA. 

Matricaria, U. S., German Chamomile, consists in the flower-heads 
of Matricaria Ohamomilla, a European plant, possessing mild bitter tonic 
properties when given in moderate dose. In larger amounts it acts as 
an emetic and anthelmintic. In the form of an infusion of the strength 
of 1 to 2 ounces to the pint (30.0-60.0 : J litre) it has been largely 
used as a diaphoretic, and, in small doses, to prevent colic in teething 
children. 

MENTHOL. 

See Peppermint.) 

MERCUROL. 

Mercurol is a chemical compound of mercury and nuclein, and 
possesses active germicidal power over pyogenic organisms. It is 
said to be particularly destructive to the gonococcus and to be of value 
in both gonorrhoea and gonorrhoeal ophthalmia. It does not coagulate 
albumin nor act as an irritant, and is readily soluble in water. In 
making the solution it should be placed on the surface of the fluid, as it 
dissolves best in this way. The solution for gonorrhoea should be of 
the strength of -|- to 1 per cent. In very obstinate cases as strong a 
solution as 2 per cent, may be needed. It is best given by injection 
into the urethra in normal salt solution. 

MERCURY. 

Hydrargyrum, U. S. and B. P., Mercury or Quicksilver, is a 
heavy fluid metal of a peculiar color and appearance. As metallic 
mercury it is used in medicine in the form of the ointment, the plaster, 
gray powder, and blue mass and the unofficial gray oil. 

Physiological Action. — When mercury is taken into the body in one 
of its insoluble and mild preparations, it may cause no evidence of its 
presence until by frequent and excessive dosage the system in general 
begins to feel its influence. The first evidences of this are to be found 
in the mouth, and consist in tenderness of the teeth when the jaws are 
firmly and quickly closed, foetid breath, sponginess of the gums, 
which finally may bleed at the slightest touch, swelling of the tongue, 
and, most prominent of all, excessive salivation, a condition some- 
times called ptyalism. If the use of the drug is persisted in, all 
these symptoms grow worse. Eczema, and finally sloughs of the chin 



298 DRUGS. 

and chest develop as the result of the constant dribbling of saliva 
and the direct depressing effect of the drug on the tissues. The teeth 
drop out, the maxillary bones undergo necrosis, and amid a general 
melting down and decomposition of the tissues the patient dies. The 
blood is affected, and becomes very thin, fluid, and poor in its corpus- 
cular elements. These symptoms ensue on the use of mercury in 
continued overdoses, and rarely follow exposure to the drug in the 
processes of the arts. In the arts — as, for instance, in the making of 
looking-glasses — workmen are often affected by various trains of symp- 
toms varying very widely in their course. In some cases the nervous 
system becomes chiefly affected. Tremors of all sorts arise, paralysis 
agitans is developed, and the results of peripheral neuritis ensue ; 
but it is worthy of note that the ocular muscles are rarely involved 
in mercurial tremor, while in disseminated sclerosis nystagmus is not 
rare. Similarly the tremors of mercurial poisoning often affect the 
head and neck alone, while in paralysis agitans this is rarely the 
case. Chorea often comes on in chronic mercurial poisoning, and the 
occurrence of choreic movements in an adult should cause inquiry as to 
any possible exposure to mercury. In other cases brownish discolor- 
ation of the skin, resembling Addison's disease, appears. Blindness, 
deafness, sensory disturbances, such as hyperesthesia and anesthesia, 
may be developed, and localized wasting of muscles or groups of muscles 
may assert itself. In still other cases the blood becomes impoverished 
and mercurial cachexia is developed. 

It is worthy of note that children under three years are rarely sali- 
vated by the use of mercury, but this is no reason for using this drug 
carelessly in this class of cases, since the other changes in the organ- 
ism nevertheless occur. 

Absorption and Elimination. — The rapidity of absorption and 
elimination of mercury depends to a very great extent on the variety 
of it which is given. The drug in some forms is so insoluble that 
very great delay in its elimination must often ensue because it is 
slowly absorbed. Several opinions are held as to the form in which 
mercury is absorbed. It is usually taught in France that the 
theory of Miahl is correct ; this is, that the mercurial preparations 
are transformed in the stomach and intestine into the bichloride, 
which in turn unites with the sodium chloride in the blood and 
circulates as a double chloride of mercury and sodium. In Ger- 
many it is taught that it forms an albuminate of mercury and so 
circulates (Henoch's theory), or that it forms a chloro-albuminate 
( Voit's theory). All these theories as to its absorption are open 
to grave criticism. As to the elimination of mercury, it is known 
to escape as an albuminate by every excretion of the body — the urine, 
frees, sweat, tears, milk, and saliva. After a single dose the drug begins 
to be eliminated in about two hours according to Byasson, and it is 
entirely gotten rid of in twenty-four hours. If, however, the doses are 
repeated it gradually accumulates in the body, and is so slowly elimi- 
nated ;is to remain for almost indefinite periods of time, and is found 
deposited in nil the organs. In other words, the doses of mercury 
ordinarily given are always large enough to produce cumulative 



MERCURY 



299 



effects. Thus while Balzer and Klumpke agree with Byasson as to 
the rapidity of elimination of a single dose, they find from an experi- 
mental study that the amount of mercury which can be eliminated by 
the kidneys for many weeks when the body is saturated with the 
drug is only one-sixteenth of a grain a day. It is evident, therefore, 
that after a full mercurial effect is produced it is well to decrease, as 
do most syphilographers, the dose of mercury and give only enough 
to maintain the effect. It is also evident that the plan of using 
iodide of potassium every now and again to aid in the elimination of 
the residual mercury is advisable. 

Therapeutics. — The employment of mercury in medicine centres 
around four great points — viz. : 1st, its value in syphilis and kindred 



states ; 2d, its use as a purge ; 3d, its power as an antiseptic and germ- 
icide ; and 4th, its action as an antiphlogistic : the first and fourth 
points are fulfilled by all the mercury salts more or less perfectly, the 
second only by blue mass and calomel, the third by the bichloride and 
biniodide of mercury. 



Fig. .48. 




Lamp for mercurial fumigations. This lamp is made of wire gauze, and resembles the safety 
lamp of miners, thereby guarding against sudden explosions of the alcoholic vapors. 

As an Antisyphilitic. — In syphilis mercury is to be given, not 
because the patient is in this or that stage of the disease, but because 
the conditions present call for its employment. Many writers have 
insisted that it ought only to be employed in the secondary stages, 
and, while this is, as a general rule, correct, certain conditions may 
call for it at any time. 

Of all the preparations of mercury used in the treatment of syphilis, 



300 DRUGS. 

the protoiodide is the most popular, and deservedly so. (See article on 
Syphilis.) 

Mercury is often administered by means of fumigations or inhala- 
tions both for the removal of local and general syphilitic disorders. 
The best apparatus for either purpose is one devised by Bumstead, and 
it is both simple and inexpensive. It consists of a sheet-iron cup so 
bent that the bottom of the vessel, instead of being flat, projects up- 
ward into the centre of the cup, thereby forming a raised centre with 
a little ditch about it. The top of this projection is flattened, and on 
its apex is placed the calomel which is to be sublimed. The sur- 
rounding ditch is then filled with hot water, and. the cup placed over 
an alcohol flame, which disengages the vapor of the calomel and 
water. (See Fig. 48.) 

When inhalations are used the face should be held some six or 
eight inches away from the cup to permit the fumes to pass through 
the air. Under these circumstances the quantity of calomel used 
should not exceed 4 or 5 grains (0.3), and the mouth should be rinsed 
out to prevent mercurial stomatitis unless a local action on the buccal 
mucous membrane is desired. Not more than eight or ten inspira- 
tions should be taken at one sitting. 

If general fumigations are to be practised, the patient places the 
lamp and cup with 30 grains (2.0) of calomel on it under a chair, on 
which he sits wrapped in a heavy blanket, and subjects himself not 
only to these fumes, but to a home-made Russian bath, which relaxes 
his skin and aids absorption. (See Fig. 49.) 

We believe that the ultimate conclusion of the profession in regard 
to the hypodermic injection of mercurials in syphilis will certainly be 
identical with that governing this use of quinine in malarial fever. 
There can be no doubt that a certain number of instances do arise in 
which, by reason of severe infection, susceptibility of the patient, or 
inability to take mercury by the ordinary means, hypodermic injec- 
tions are absolutely necessary. In the same way that we give qui- 
nine by the mouth, the rectum, and hypodermically in pernicious 
malarial fever, so do we give mercury by the mouth, by inunctions, 
by sublimation, and by the hypodermic needle in malignant syphilis. 
The reasons for believing that hypodermic injections of mercurials 
are not to be resorted to in the routine treatment of syphilis are sev- 
eral. In the first place, all forms of hypodermic medication possess 
disadvantages not possessed by the use of drugs by the mouth. There 
is always danger of entering a vein, of producing an abscess, or of 
causing local pain. When mercurials are so employed, the danger 
of abscess, of pain, or of milder inflammatory manifestations "is 
greatly increased, and the presence of an indurated spot where the 
hypodermic injection has been given proves that it is not the best 
form of medication in syphilis. Of the mercurial preparations which 
may be administered hypodermically in syphilis, the two which sur- 
pass all others arc undoubtedly the bichloride of mercury, in the 
dose of J grain, dissolved in 10 or 15 minims of distilled water, every 
second or third day, or gray oil (Oleum Oinereum), which was first 



MEUCVUY, ' 301 

introduced into medicine by Lang of Vienna. (See Gray Oil, under 
Mercury.) 

In all cases the injection should be given slowly and deeply into some 
portion of the body in which the tissues are loose, as the buttock or the 

Fig. 49. 




A patient prepared for the use of mercurial sublimations. A blanket having been pinned 
tightly around the neck after the patient is stripped, the fumigator shown at his feet is 
placed under his chair and the calomel placed on the central disc, as shown in the illus- 
tration. Water is in the little ditch around it and an alcohol lamp under it. The patient 
should be given a full, warm bath beforehand to cleanse and prepare the skin for absorption. 

broad of the back, and the skin of the part where the injection is to be 
made should be carefully washed and sterilized by the use of green 
soap and alcohol. 

The intravenous injection of bichloride of mercury has been proved 
so dangerous as to be properly considered unjustifiable. 

It is to be recalled that the herpes seen in advanced syphilitics is 
usually made worse by mercury. Also, that headache due to syphilis, 
if due to a cerebral growth, is benefited by mercury ; while that due 
to anaemia and debility complicating syphilis is increased by the use of 
the drug. 



302 DRUGS. 

As A Purge. — The employment of mercury as a purge or laxative 
having a special action on the liver is constantly resorted to. The two 
preparations used are blue mass and calomel, but the latter is more 
active. They both cause soft or watery stools, according to the dose in 
which they are given, but the blue mass is rarely, if ever, used except 
for the production of a laxative effect. 

Much discussion has arisen as to whether mercury affects the liver, 
and whether the peculiar greenish or brownish-yellow stools produced 
by it are due to the presence of bile or mercury. 

If there is one point firmly fixed in the mind of the average 
practitioner of medicine, it is that the mild chloride of mercury 
increases the quantity of bile in the intestine. If such a believer 
is questioned as to whether this increased amount of biliary fluid 
is due to a true increase in secretion or simply to an increase in 
the flow of bile from the gall-bladder, he will either state that he 
is unable to answer the question or that he believes that it is an 
increased secretion. 

Practically, the position of the profession in general in regard to 
the purgative influence of calomel is that the drug exercises a stim- 
ulating effect upon the biliary gland. Careful experimentation upon 
the lower animals by several competent observers, and careful studies 
made by physiological chemists, fail, however, to give us very much 
light upon this subject. It is held by some that calomel never acts 
as calomel, but is converted by the hydrochloric acid of the gastric 
juice into corrosive sublimate, and that this drug then stimulates the 
liver to increased activity. 

On the other hand, the best chemical investigations show positively 
that the feeble acidity of the gastric juice and the temperature to 
which the calomel is exposed are not favorable to the conversion of a 
sufficient quantity of calomel into corrosive sublimate to account for 
any hepatic influence. Thus it was found by Rutherford and Yignal, 
in their well-known series of studies upon the influence of drugs upon 
the secretion of bile, that if 5 grains (0.32) of calomel are subjected, 
at 100° F.. for seventeen hours to the action of normal gastric juice, 
not more than -^ of a grain of mercuric chloride is produced. As 
calomel does not remain in the human stomacli for more than a day 
at the utmost, and generally but a very few hours, it is not likely that 
as much as -^ of a grain of mercuric chloride is produced from the 
moderately large dose of 5 grains (0.32). 

In contradiction of this, Bucheim, Winkler, and others assert that 
no conversion whatever takes place at the temperature of the body, 
and Jaennel's later studies support this view. 

The other theory as to the change which takes place in calomel 
prior to its action upon the liver is that it escapes into the intestine, 
where it is decomposed and the gray oxide of mercury precipitated, 
which may, however, be held in solution by any fatty materials, which, 
being mixed with alkaline liquids, practically form soaps. It is thought 
by Wood and others that this is the more probable result, particularly 
in view of the fact that calomel acts more like blue mass than cor- 



MERCURY. 303 

rosive sublimate. Further than this, these opinions are confirmed by 
the fact, with which all of us are familiar, that the hepatic influence 
of calomel is much more positively asserted if at the same time small 
doses of the bicarbonate of sodium are administered. Under these 
circumstances the bicarbonate of sodium naturally diminishes, to some 
extent at least, the acidity of the gastric contents, and also directly 
or indirectly tends to increase the alkalinity of the contents of the 
duodenum. 

As if to increase the complexity of the problem, the studies of 
Rutherford and Vignal seem to prove conclusively that in the dog, 
at least, mercuric chloride has a direct stimulant effect upon the 
hepatic cells; whereas, calomel, while producing purgation by increas- 
ing the secretion of the intestinal glands, in no way increases the true 
secretion of bile ; and this would seem to indicate that, after all, the 
influence of calomel upon the liver is due to a very minute portion 
of it being changed into corrosive sublimate. Probably the truth of 
the matter is, that we have as yet no definite scientific explanation of 
how calomel really does act. It may be that the solution of the problem 
lies in the hepatic influence exercised by the presence of minute quan- 
tities of corrosive sublimate, and the purgative effect produced by that 
portion of the calomel which has not been converted into the strong 
chloride of mercury. This is rendered the more likely in view of the 
fact that the corrosive sublimate has been found a feeble intestinal 
stimulant, while the calomel has been found to produce active purga- 
tion in dogs, without producing an increase in biliary flow, when the 
drug has been introduced into the duodenum. 

It has been suggested, too, that calomel itself may stimulate the 
bile-expelling mechanism, while the minute portion of corrosive sub- 
limate increases the secretion of the liquid ; and, again, that by means 
of the purgative effect that it produces certain substances which have 
been in the intestine are immediately removed, and, as a consequence, 
a depressant influence upon the hepatic cells no longer exists. 

Quite a number of physicians have studied the effect of the various 
so-called cholagogue drugs upon the flow of bile in human beings who 
have had biliary fistula. Perhaps the best studies are those of Pfaff 
and Balch, and more recently those of Joslin, upon women with biliary 
fistula. Calomel and the bichloride of mercury seemed invariably in 
these cases to decrease rather than increase the biliary flow. Ox-gall 
was the only drug which did increase it. 

This subject also is of interest to the practical physician in rela- 
tion to the administration of calomel in compressed tablets or other 
preparations when mixed with what might be called excipients. Under 
these circumstances, if one of the excipients is bicarbonate of sodium, 
the tablet after a time almost always undergoes a change and becomes 
of a gray color. Those who have used pills or tablets of calomel which 
have been kept for a long period of time seem to be universally in 
accord with the statement that they have lost the hepatic effect which 
a recently prepared powder always possesses. Thus it has been fre- 
quently found that no biliary flow occurs under the use of stale tablets, 



304 DRUGS. 

whereas free bilious purging follows the administration of freshly 
prepared powders. 

Calomel and blue mass are largely used in the condition known as 
biliousness, and undoubtedly give relief. (See Biliousness.) If the 
tongue is heavily coated, the breath foul, the conjunctiva a little 
icteroid, and headache is present, one of them should be employed. 
In remittent malarial fever the use of small repeated doses of calomel 
will often bring relief from the vomiting, and it should always be 
given in the treatment of malarial disease before quinine is used if a 
thorough action of the antiperiodic is required, as it aids in the absorp- 
tion of the drug. 

As a Disinfectant. — The disinfectant and germicidal power of 
bichloride of mercury and of the biniodide is very well established by 
clinical experience and experimental investigation. The strength of 
the bichloride in solution for antiseptic purposes may vary from 1 to 
2000 to 1 to 20,000 of water, and for disinfectant use from 1 to 500 
to 1 to 1000. (See Antiseptics.) 

In using the bichloride of mercury as an antiseptic it is necessary 
to add a few grains of tartaric acid to the solution to prevent its unit- 
ing with the albumin of the tissues to form an insoluble and useless 
albuminate. The same is true of the use of mercury biniodide. 

As an Antiphlogistic. — The antiphlogistic or anti-inflammatory 
action of mercury is very marked indeed, but its employment is abso- 
lutely limited under these circumstances to one variety of inflamma- 
tion — namely, the sthenic or dynamic form. In inflammation arising 
during the course of some exhausting disease mercury is not only con- 
traindicated, but harmful. Thus, if a man in health is stricken with 
pleurisy or peritonitis or meningitis or any acute inflammation of a 
serous membrane, be the cause what it may, the exudate poured out 
will probably be fibrinous, and capable of undergoing organization, 
thereby causing adhesions of the pleural surfaces, of the intestines, or 
of the meninges of the brain. On the other hand, if a man be taken 
with pleurisy or meningitis during the course of phthisis or typhoid 
fever, the exudate is often serous and large in quantity. It is in the 
first case that mercury should be used to prevent the fibrinous exudate 
or to make it serous. In the second instance it will do harm by increas- 
ing the exudation. 

When mercury is given as an antiphlogistic, opium is often combined 
with it to relieve the pain and irritation and to prevent purging. In 
meningitis arising from head injuries this is a routine treatment, and 
may be carried out by the use of powders containing ^ grain (0.015) 
of calomel and -J grain (0.015) of powdered opium every hour till 1 or 
1| grains (0.05-0.07) of each are taken. The simultaneous use of 
the ice-bag to the head and perfect quiet will often bring relief very 
rapidly. 

Mercury is also the best remedy in sthenic endocarditis, and should 
l)c given in full dose. The bichloride may be used in small doses in 
place of the calomel, and does not, of course, produce the same tend- 
ency to laxity of the bowels. On the other hand, it often seems to be 

LeSfi efficacious. 



MERCURY. 305 

Mercury in myocarditis and pericarditis is also of service, and 
certainly exerts distinct medicinal power in the early stages of 
diphtheria, although since the introduction of antitoxin its use in 
diphtheria is very limited. (See Diphtheria.) 

One of the best ways to employ all of the various forms of mer- 
cury is in the form of triturates, which may be prepared by triturating 
10 parts of the drug with 90 parts of milk-sugar. The minute sub- 
division of the medicament aids in its efficiency, because of its more 
ready absorption. 

Leaving the general subject of mercury, we may now consider each 
individual preparation. 

Ammoniated Mercury. 

White Precipitate, or Ammoniated Mercury of the strength of 10 
per cent, with lard {Hydrargyrum Ammoniatum, TJ. S. and B. P.), is 
used in an ointment ( Unguentum Hydrargyri Ammoniati, TJ. S. and 
B. jP.) in various skin affections, when a stimulating application is 
needed, as, for example, in psoriasis and chronic dry eczema. It is also 
sometimes employed as a parasiticide in cases of tinea. The official 
ointment should generally be diluted with lard, as it is far too strong 
and will often induce a dermatitis if used undiluted. 

In ozcena, whether syphilitic or not, Trousseau has recommended the 
employment of the following powder as a snuff : 

R.— Hydrargyri ammoniati . gr. iv (0.2). 

Pulv. sacchar. alb. Jjss (15.0). — M. 

S. — To be used as a snuff, after thoroughly blowing the nose. 

The red precipitate may be used instead of the white. The treat- 
ment removes the stench and may cure the complaint. It may, how- 
ever, irritate the mucous membrane, in which case it should be used in 
the strength of 2 grains to the ^ ounce (0.1 : 15.0). Ammoniated 
mercury is never used internally. 

Bichloride of Mercury. 

The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyri 
Chloridum Corrosivum, TJ. S. ; Hydrargyri Perchloridum, B. P.), as 
it is called, is an exceedingly poisonous and irritating substance when 
taken internally in concentrated form. 

Taken internally, it causes violent pain in the stomach, vomiting, 
purging of mucus, blood, and the contents of the intestine, collapse, 
syncope, and death. If taken in poisonous amount, the patient should 
be made to swallow large quantities of the antidote, white of egg, the 
stomach should be washed out with the stomach-pump, heat should 
be applied about the body, and the proper stimulants be given if 
the pulse or respiration fail. If death does not occur at once, the 
patient generally has a protracted convalescence or else dies from the 
organic changes produced in the gastro-intestinal tract, such as strict- 
ures, sloughs, destruction of the peptic glands, and ulcerations. 

The bichloride of mercury is an exceedingly useful preparation 

20 



306 DRUGS. 

of mercury for hypodermic injection in syphilis, and is better than 
calomel for this purpose. About \ grain (0.012) may be injected 
deeply and gently into the cellular tissues every two or three days. 
When the injections are made the greatest possible cleanliness should 
be obtained. The needle should be aseptic and the hands of the 
operator well disinfected. The best place for the injection is in the 
gluteal region or between the shoulder-blades. 

Mercury bichloride, aside from its antiseptic use (see Antiseptics), 
is of great value when given internally, not only in syphilis, but in 
other states not associated with any such depraved condition, as in 
chronic B right's disease. In diphtheria it may be used to prevent 
fibrinous exudation as readily as calomel (see Diphtheria), and in ton- 
sillitis, where the inflammation is severe, it is often used with great 
service. 

In small amounts — that is, in -^ to -^ of a grain (0.0015-0.0017) 
three times a day — the bichloride is one of the best remedies which we 
possess for the treatment of anosmia depending upon a deficient num- 
ber of blood-cells. If the angemia is syphilitic in origin, it is, of course, 
peculiarly useful. 

Bichloride of mercury is of value in minute doses of jj^ of a grain 
(0.0003) for the ill-smelling green stools of summer diarrhoeas in 
adults and children, and it has been recommended that a solution 
be made of \ a grain (0.03) in 5 ounces (150.0) of water, and a tea- 
spoonful given every hour until relief is obtained. The water used 
in making the solution should be distilled, and it may be well to add 
to it a little tartaric acid to prevent precipitation of the bichloride by 
organic matter which may have gotten into the water. This treat- 
ment is particularly useful in mucous diarrhoea in which blood and 
mucus are thoroughly mixed. Patients in the dispensaries often speak 
of these passages as containing "corruption," and others think they 
consist of "lumps of flesh," owing to the masses of blood and mucus. 
Whether the disease be acute or chronic, the bichloride, used in the 
way just described, will be found of service. In dysentery and the 
diarrhoea of adults the same treatment may be resorted to, using 2 
teaspoonfuls of the solution instead of 1. It is hardly necessary to add 
that the greatest care must be bestowed upon the diet and clothing. 
The author has treated a child suffering from persistent diarrhoea for 
months with varying success, only to succeed when, it being found 
that the abdomen was exposed to the air, the mother was forced to 
apply and keep on the child a flannel binder. 

In some cases in which an obstinate syphiloderm is present \ an 
ounce (15.0) of corrosive sublimate and 1 ounce (30.0) of chloride of 
ammonium may be added to a warm bath, which should be taken 
every few days. \ a grain (0.03) of the bichloride of mercury in 6 
ounces | 180.0) of water is said to be most efficient as an injection in 
gleet, if used every three or four hours. (See Gonorrhoea.) 

In all parasitic affections of the skin a solution of 2 grains (0.1) 
of bichloride to the ounce (30.0) of water may be sopped on the pari 
three times a day. A solution of porchloride of mercury {Liquor 
Wydrargyri Perchloridi) is official in the B. P.; it is prepared by 



MERCURY. 307 

adding \ grain (0.03) of the perchloride of mercury to 1 ounce (30.0) 
of water, with \ grain (0.03) of ammonium chloride to hold it in solu- 
tion. 

(For the antiseptic uses of the bichloride of mercury see Antiseptics 
and Disinfectants.) 

Biniodide of Mercury. 

Mercury Biniodide {Hydrargyri Iodidum Rubrum, U. S. and P.P.) 
is a bright-red powder, possessing irritating powers equal to or above 
those of the bichloride, and causing symptoms, when taken in over- 
dose, closely resembling those produced by the latter drug. Owing 
to the formation of the salt, it is thought to be particularly useful in 
the later stages of syphilis. The dose is -^ to -^ of a grain (0.003- 
0.006). (See Syphilis.) An ointment (Unguentum Hydrargyri Iodidi 
Rubri, B. P.) is useful as an application in goitre and obstinate shin 
diseases. 

At one time it was thought that biniodide of mercury was a better 
antiseptic than the bichloride, but recent researches have proved that 
this is not a fact. 

Black Wash. 

Black Wash (Rotio Hydrargyri Nigra, B. P.) is made by adding 
1 drachm of calomel to a pint (4.0 : J litre) of lime-water. It is used 
as a stimulant application for washing syphilitic sores and ivounds and 
in various forms of eczema. 

Blue Mass. 

Blue Mass (Massa Hydrargyri,!/. S. ; Pilida Hydrargyri, B. P.) 
is made by rubbing up metallic mercury with liquorice and other 
excipients, and is often called Blue Pill. Each grain of the mass 
contains | grain (0.02) of mercury, and it may be given in the dose 
of from J to 20 grains (0.03-1.3) for the same laxative purposes for 
which we use calomel. Blue mass is rarely used to produce systemic 
effects. 

Calomel. 

Calomel (Hydrargyri Chloridum. Mite,U. S. ; Hydrargyri Subchlo- 
ridum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt 
which is, nevertheless, freely absorbed. 

Calomel when used as a laxative purge should be given in the dose 
f i to J grain (0.01-0.03) every half-hour or every fifteen minutes until 
1 or 2 grains (0.05-0.1) are taken, as it will often act as efficiently in 
this way as if 10 grains (0.65) are given at one dose, and there is no 
danger of producing ptyalism. The reason that small doses are as 
efficient as large ones Ties in the fact that only the calomel which is 
changed into the gray oxide is active, and, as the amount of alkaline 
juicem the intestine is small, only a minor part of a large dose of 
calomel acts, the major portion escaping unchanged. This is the 
reason that bicarbonate of sodium is added to calomel powders, to aid 
the intestinal juice in the reduction of the salt. While this state- 



308 MERCURY. 

ment is true of the use of calomel in temperate climates, it does not 
hold good in hot climates, where much larger doses, amounting to 10 
(0.65) or even 20 grains (1.3) are often given to affect the flow of bile, 
the hepatic gland being made torpid by heat. If purgation does not 
occur after a full dose of calomel, a saline purge must be given at the 
end of the twenty-four hours, and this must always be used if large 
doses of the mercurial are employed, to avoid possible mercurialization. 

Mercury in the form of calomel has been used hypodermically in 
the treatment of syphilis, being held in solution by a mucilage. Best 
of all, however, is the employment of chloride of sodium in water with 
the calomel, in the proportion of 5 parts each to 50 parts of water. 
It should be injected deeply into the tissues, not immediately under- 
neath the skin, the greatest cleanliness being necessary to avoid 
abscesses. The best place for these injections is in the fold of the 
buttocks, but sloughing, tetanus, and even gangrene, have followed its 
employment in this way. (See also Salicylate of Mercury and 
Bichloride of Mercury.) 

In dysentery of the acute form calomel and ipecac are valuable 
remedies. (See Dysentery and Ipecac.) The calomel should be given 
in small doses, repeated every hour or half-hour until a favorable 
change in the number and character of the stools appears. Calomel 
is not to be used if great asthenia complicates the disease. 

In children who seem constantly " under the weather " and never 
quite well, who have flatulence, foetid breath, and ill-smelling, pasty 
stools, calomel often gives great relief in the dose of 2V of a grain 
(0.003) every half-hour until four doses are taken, this treatment 
being pursued every fourth or fifth morning. 

In jaundice due to exposure to cold and to slight hepatic conges- 
tion 1 of a grain (0.01) of calomel every half-hour until 1 grain 
(0.06) is taken will often bring relief. 

Calomel is generally prescribed in conjunction with sugar of milk, 
white sugar, or bicarbonate of sodium, which are added to increase 
the bulk and wieldiness of the powder, and, in the case of the latter 
ingredient, to increase its activity. Owing to its lack of taste, calomel 
is often placed on the tongue in children, and for this class of patients 
white sugar is to be used in small quantity, as the other vehicles are 
less agreeable. The most agreeable form of administration is by means 
of triturates. 

It is important to remember that calomel, when used as an anti- 
syphilitic, produces salivation very much earlier than the other mer- 
curials. 

Sometimes calomel is of value when dusted into the eye in cases 
of /thlifctenular conjunctivitis which arc strumous. This practice 
musl not be resorted to if iodine or iodides are being taken inter- 
nally, as the iodine is eliminated by the tears and forms a compound 
whirl) burns the conjunctiva. 

A very important use of calomel, and one which has been brought 
forward very recently as new, but which is really many years old, is 
it- employment in dropsy as a diuretic, either alone or combined with 
squills or digitalis, or with opium to prevent purging. The dose is 



MERCURY. 309 

small, about 1 grain (0.05) thrice a day, and if a diuretic influence 
does not assert itself in forty-eight hours it should not be continued. 
How calomel acts to produce the increased urinary flow under these 
circumstances we do not know. Some suppose that it aids the absorp- 
tion of liquid from dropsical tissues, and so increases urinary secre- 
tion ; others think that it stimulates the renal epithelium to greater 
activity. The latter seems the least probable of the two, but neither 
theory has been proved correct, although experimentation supports 
the view first named. The full urinary effect of the drug is not felt 
till the second or third day of its use, and speedily passes away, par- 
ticularly as purging is often induced very early. Still another use 
of calomel is in typhoid fever, in which disease it has been highly 
recommended in small repeated doses, particularly if constipation is 
present. In the opinion of the author this is disadvantageous as a 
routine measure and entirely uncalled for, although in the very early 
stages of the disease, when the bowels are confined and the tongue 
coated, a dose of 1 grain (0.05) in fourths with a little bicarbonate 
of sodium is useful. 

Sydney Ringer has called attention to the fact that in constipa- 
tion or in " biliousness " podophyllin does more good than calomel, 
provided that the stools are dark in color, whereas if the same signs 
are present, but the stools light and clayey in color, calomel is more 
efficient. The author has proved the correctness of this assertion so 
frequently that he is convinced of its truth. 

Calomel has been recommended in the condition of anorexia and 
depression following acute diseases, and when the tongue is covered 
by a thick yellow coat it is the remedy for the gastro-intestinal tor- 
por always present. While purgative doses of calomel certainly are 
of value, the use of freshly-prepared nitro-muriatic acid is, however, 
highly preferable to the mercurial salt in many such instances. Both 
of these drugs should not be given simultaneously, because they are 
incompatible. 

Calomel is often given in small doses to "settle the stomach." 
Sometimes it will act in this way, but in other cases it will seem to 
increase the nausea and bring on vomiting. This is true of both 
adults and children, and it is impossible to tell beforehand which will 
occur. Ringer asserts that in a peculiar form of vomiting occurring 
in very young children, which comes on immediately after the food is 
swallowed, the rejection of milk being forcible, and perhaps so sudden 
that it is not even curdled, and which is not accompanied by much 
straining, calomel will often give relief when all other remedies fail. 
It should not be resorted to until some evidences of wasting occur, as 
this action of the stomach in many children only rids that organ of 
that part of the milk which is in excess, and is a purely physiological 
regurgitation. The calomel may be given in the dose of y 1 ^- of a 
grain (0.005) every hour, or, if preferred, gray powder in the dose 
of -J- of a grain (0.02) every hour for three doses is equally efficient 
in these cases. 

Calomel in a fine powder will often remove syphilitic condylomata 
if dusted over them for some time, and an ointment made of 1 drachm 



310 DRUGS. 

(4.0) of calomel to 1 ounce (31.0) of lard is very useful in pruritus 
am. 

The B. P. contains a pill mass of calomel, called Pilula Hydrargyri 
Subchloridi Composita, which contains antimony, guaiac resin, and 
castor oiL Its dose is 2-8 grains (0.1-0.5). 

Calomel ointment ( Unguentum Hydrargyri Subchloridi, B. P.) is 
often useful in the treatment of small patches of eczema, or the fol- 
lowing prescription may be given for its use : 

R. — Hydrarg. chlor. mit gr. xl (2.65). 

Magnesise carbonatis gr. xl (2.65). 

Unguent, aquae rosae Jj (30.0). — M. 

Gray Oil. 

Gray Oil {Oleum Cinereum) is prepared as follows: 2 drachms 
(8.0) of lanolin are rubbed up with sufficient chloroform to emulsify it. 
The rubbing process is continued until most of the chloroform is 
evaporated, and while the mixture is still in a fluid, state metallic 
mercury, in double the amount of lanolin, 4 drachms (15.0), is added 
and the trituration continued. By this means an ointment of mercury 
is left which equals 2 parts of mercury and 1 of lanolin. This is 
sometimes called Strong Gray Ointment. For hypodermic injection 
3 parts of this gray ointment are added to 1 part of olive oil, or it may 
be still further diluted by adding olive oil in the proportion of half- 
and-half. Of this mixture 1 to 2 minims (0.05-0.1) may be injected 
every second or third day. 

By some practitioners this preparation is considered much better 
than any other for hypodermic use in syphilis. 



Mercury with Chalk. 

Mercury with Chalk (Hydrargyrum cum Or eta, U. S. and B. P.), 
or Gray Powder, is slightly purgative, but is chiefly employed in the 
treatment of iiifantile syphilis, as it will not freely purge. It is com- 
posed of 38 parts of mercury, 12 parts of sugar of milk, and 50 parts 
of prepared chalk. The dose is 1 to 10 grains (0.06-0.65). Chil- 
dren suffering from syphilitic marasmus seem fairly to fatten on it. 
This preparation is also of service in the syphilis of adults, and may 
be employed whenever the laxative effect of mercury is not desired. 

In the treatment of infantile diarrhoea with watery, colorless stools 
containing undigested food gray powder in small doses is often very 
useful. 

Mercury Ointment. 

The Ointment of Mercury, Mercurial Ointment ( Unguentum 
Hydrargyri, U. 8. and B. P.), sometimes called Blue Ointment, is 
made by rubbing up mercury with suet and lard until the mercury is 
extinguished, or, in other words, until the globules of mercury cannot 
he seen with a magnifying power of ten diameters. 

The ointment of mercury is used externally in certain skin affec- 



MERCURY. 311 

tions and for the purpose of influencing the general system in cases 
where the drug cannot well be taken by the mouth. In syphilis 
where a mercurial effect is to be reached the ointment in small amounts 
should be thoroughly rubbed into the skin in various parts of the 
body — one evening in the left groin, the next in the right groin, the 
next evening in the left axilla, and the fourth evening in the right 
axilla, beginning on the fifth evening in the left groin once more. 
This avoids local irritation of the skin by means of too frequent 
applications, places the drug on spots where it is readily absorbed, 
and very rapidly influences the system of the patient. In infantile 
syphilis this method may be employed, or a flannel binder covered 
with the ointment may be placed about the belly. The clothes should 
not be changed too frequently, as their saturation with the drug aids 
in producing the impression upon the system, and the wearing of an 
undershirt saturated with the ointment after a .few days' wear is a 
very valuable, though somewhat dirty, method of producing mercu- 
rialization. 

The ointment of mercury is sometimes rubbed into the skin over 
enlarged glands. 

Under the name of Oleate of Mercury (Oleatum Hydrargyria U. S. ; 
Hydrargyri Oleas, B. P.) a very efficient and more agreeable appli- 
cation than the ointment is used in its place or still further diluted 
with lard, when it becomes the Unguentum Hydrargyri Oleatis, B. P. 
It is made from the yellow oxide of mercury. (See Oxides of Mercury.) 

For pediculus pubis, or in any case where parasites, such as the 
flea or louse, infest the region of the genitals or any spot covered by 
a hairy growth, mercurial ointment may be used as a remedy, owing 
to its lethal influence over these troublesome pests. Care should be 
taken that it does not cause salivation of the patient, and it must not 
be allowed to remain on the parts, but be wiped off in the course of 
an hour or two or less. The following words from the pen of Dr. 
Joseph Leidy are sufficiently interesting to demand a place at this 
juncture : " We may here say that if it is once understood that all 
insects, including lice, are destroyed quickly by the application of 
any fixed or volatile oil, physicians will see there is no necessity of 
employing remedies of a noxious character to the patient. The fat 
of mercurial ointment is probably more active than the mercury 
itself. 

Linimentum Hydrargyri, B. P., and Emplastrum Hydrargyri, 
TJ. S. and B. P., are used for the same purposes as is the ointment 
of mercury. The plaster is made with olive oil, resin, and lead plas- 
ter instead of ordinary suet or lard. 

Nitrate of Mercury. 

The Solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, 
IT. 3., and Liquor Hydrargyri Nitratis Acidus, B. P.), Acid Nitrate 
of Mercury, is an exceedingly active, penetrating caustic, so rapid in 
its effects that it seems to drop through the tissues. It may be em- 
ployed for the removal of epitheliomata and large warts, and should 



312 DRUGS. 

be applied by means of a glass rod. This treatment may also be 
resorted to with advantage in lupus until the surface of the growth is 
level with the skin. The surrounding parts should be protected by 
lard or oil. As this treatment is very painful, the spot may be first 
cocainized and afterward covered with flexible collodion. 

Citrine Ointment ( Unguentum Hydrargyri Nitratis, U. S. and 
B. P.) is used as a stimulating application in cases of chronic shin 
diseases of the scalp and trunk. It is too strong for ordinary use, 
and should be diluted one-half or less with lard according to the stim- 
ulating effect required ; the dilute ointment is official in the B. P. as 
Unguentum Hydrargyri Nitratis Dilutum. 

Oxides of Mercury. 

The Yellow and Red Oxide of Mercury (Hydrargyri Oxidum 
Flavum, U. S. and B. P. and Hydrargyri Oxidum Rubrum, U. S. 
and B. P.), Red Precipitate, are used largely as a dressing for syph- 
ilitic sores when diluted about one-half with chalk or other powder. 
If used pure, they are somewhat caustic. From the yellow oxide is 
made the Oleate of Mercury (Oleatum Hydrargyri, U. S.), which is 
used for the same purpose as ordinary mercurial ointment. 

In intestinal and gastric indigestion, with foul belching and very 
ill-smelling stools which are due to intestinal sepsis, the yellow oxide 
is sometimes given in the dose of g 1 ^ to ^ of a grain (0.001-0.0012) 
in a triturate. 

Red Precipitate Ointment ( Unguentum Hydrargyri Oxidi Rubri, 
U. S. and B. P.) and the Ointment of the Yellow Oxide ( Unguentum 
Hydrargyri Oxidi Flavi, U. S. and B. P.) are largely used, diluted 
one-half with lard, for chronic scaly skin affections, in obstinate con- 
junctivitis, and in granular lids and styes. (See Styes.) They should 
always be freshly prepared. 



Protiodide of Mercury. 

Mercury Protiodide (Hydrargyri Iodidum Flavum, U. S.) is much 
more mild than the biniodide, and is given for exactly the same pur- 
poses. It is very useful in chronic Bright 's disease. It is to be 
remembered as the best mercurial preparation for ordinary cases of 
syphilis. (See Syphilis, Part IV.) The dose is ^ to \ of a grain 
(0.01-0.016) three times a day. 

Salicylate of Mercury. 

Salicylate of Mercury is a drug which has come into quite general 
use since the introduction of the hypodermic method of administer- 
ing mercury in syphilis. It is to be suspended in paraffin oil in the 
proportion of 22 grains (1.5) of the salicylate of mercury to 3 
drachms (12.0) of the oil, and before it is used the bottle must be 
well shaken in order that the insoluble mercury may not remain at 
the bottom, it is of great importance that the needle and syringe 



METHYL BLUE. 313 

shall be thoroughly cleansed after each injection, as the insoluble 
drug readily clogs the instrument. At first 1 minim (0.05) of the 
mixture just named should be injected deeply into the gluteal region 
every fourth day, and this may be increased to every second day if no 
systemic evidences of the action of the drug appear.. 

Yellow Sulphate of Mercury. 

Hydrargyri Subsulphas JFlavus, U. S., has been used under the 
name of Turpeth Mineral as an errhine in chronic ophthalmia and 
also as a prompt emetic in croup. It is a quick and certain emetic, 
and, it is claimed, does not produce depression, but the writer would 
recommend great care in its use. The dose for a two-year-old child 
is 2 to 5 grains (0.1-0.35), repeated in fifteen minutes if necessary. 

If as much as 5 grains (0.35) has been given, and emesis does 
not follow, other emetics or the stomach-pump must be used to pre- 
vent gastro-intestinal irritation. 

Yellow Wash. 

Yellow Wash (Lotio Hydrargyri Flava, B. P.) is made by adding 
30 grains (2.0) of corrosive sublimate to a pint (-J- litre) of lime-water. 
It is used for the same purposes as the black wash already mentioned, 
but is much more stimulating in its influence. 

Incompatibles. — Bichloride of mercury should never be given with 
any other substance except iodide of potassium and chloride of ammo- 
nium, as it is incompatible with almost every other drug. With the 
iodide of potassium it may be used, because the precipitate formed is 
at once redissolved and the resulting mixture is highly alterative. 

Calomel should never be given with iodides or bromides, and hydro- 
chloric acid may convert it into the bichloride if the acid is present in 
any amount. It is also incompatible with antipyrin. 

METHYL BLUE. 

Methyl Blue or Methyl Violet is an aniline dye often sold under 
the name of Pyoktanin. When used medicinally, it must be perfectly 
pure and deprived of its usual contaminating matter, arsenic, which if 
present causes local irritation of the part to which it is applied. Pyok- 
tanin was introduced to professional notice under this name by Still- 
ing as an antiseptic, but careful study has proved it to be of very 
feeble power over the growth of germs. In all conditions of the eye 
in which antiseptic lotions are indicated pyoktanin has been stated to 
be of value, but elsewhere in surgery it is practically useless as an 
antiseptic. Even in the eye it possesses, according to de Schweinitz, 
a very limited range of usefulness, being no better than the older 
antiseptics, except in diseases of the lachrymal apparatus. The fact 
that pyoktanin stains everything it touches is a great disadvantage in 
its use. It may be tried in blepharitis, eczema of the eyelids, con- 



314 DRUGS. 

junctivitis, both simple and phlyctenular, and in the treatment of 
corneal ulcer. When so employed it should be applied in the strength 
of 1 to 1000 of water. 

It should be remembered that any pure aniline dye may be used 
in place of pyoktanin. Thus some physicians have used yellow pyok- 
tanin or auranine. 

Methyl blue and similar aniline substances are largely employed by 
. some persons in the treatment of malignant neoplasms. The solution 
(1 to 500 of water) should be filtered through hot asbestos to render it 
sterile, and every antiseptic precaution carefully adhered to in giving 
the injection. The dose is J to 3 drachms (2.0-12.0) of this solution 
every other day or every third day, and the injection is to be given 
either into the growth itself if it is large, or just at its side, in the 
healthy tissues, if it is small. Too much should not be injected into 
one spot, lest it cause a slough. This treatment does not cure the 
disease. It relieves pain and so quiets the patient, and in rare cases 
stops the growth of the tumor. If the growth sloughs, complete anti- 
septic dressing is necessary. An antiseptic pyoktanin-gauze dressing 
should always be used while the treatment is going on. 

METHYL CHLORIDE. 

Methyl Chloride is a colorless gas, easily liquefied under pressure, 
with an odor resembling that of ether and chloroform, used to produce 
local anaesthesia, which it does by absorbing a large amount of heat 
on passing from the liquid to the volatile state as it strikes the skin. 
It is usually kept in a small flask which has its end fused into a fine 
point. This is broken off, and the heat of the hand volatilizes the 
drug, which is then forced out of the flask in a fine spray. The 
nozzle should be held ten to twelve inches from the part to be frozen. 
The skin of the part to be anaesthetized should be washed with soap 
and ether to remove all fatty substances before the spray is used. 

Under these circumstances the skin becomes pale in a few seconds, 
and afterward perfectly white and parchment-like in appearance. 
Local anaesthesia is now complete, and minor surgical operations, 
such as opening boils or abscesses, can be performed without pain. 
The spray should not be continued more than two to four minutes, as 
local death of the tissues may result. A great advantage of the spray 
of methyl over that of ether is its slight inflammability and rapidity 
of action. Methyl chloride is to be distinctly separated from methyl- 
ene chloride. The first is monochlormethane, the second dichlorme- 
thane. 

METHYLENE BLUE. 

Methylene Blue is to be distinctly separated in the mind of the 
student from methyl blue, which is practically what is known by the 
trade name kk Pyoktanin." 

Methylene blue lias been employed in the treatment of malignant 
growths and in malarial fevers with asserted success, although its suc- 
cessful use in the first group of cases is decidedly problematical. When 
used in the treatment of sarcoma and cancer, from J to 2 grains (0.03- 



METHYLENE CHLORIDE. 315 

0.12) in watery solution are injected daily or on alternate days directly 
into the growth. The neoplasm, it is said, ceases to grow, shrinks, 
and comes away, leaving a fairly healthy sloughing surface. This 
treatment is so uncertain that it should only be tried in inoperable 
cases, and in this class of patients its local use often seems to relieve 
the pain and check the fetor. 

In malarial fever of the intermittent type methylene blue seems 
to possess very distinct curative powers. It is not so powerful as 
quinine by any means, but has its chief sphere of usefulness in 
patients who cannot take quinine or where quinine has been tried 
unsuccessfully. This antimalarial influence is due to its destruction 
of the plasmodium malarice, but its administration must begin from 
seven to ten hours before the expected intermittent paroxysm and 
be continued after the attacks have ceased and for some little time 
after the physician fails to find the micro-organism in the blood, as 
relapses are common. Particularly good results seem to follow the 
use of methylene blue in children suffering from malaria. Untoward 
symptoms from its use are not common, but when they do occur con- 
sist in slight vertigo, nausea, and some strangury. The urine is 
always blue from the elimination of the drug through the kidneys. 

Recently Levy has employed methylene blue in the dose of from 1 
to 2 grains (0.05-0.1) four times a day in the treatment of migraine. 
It is to be given in capsule with kola. He states that as much as 15 
grains (1.0) may be given in a clay with saf ty. 

Methylene blue has been highly commended by Horwitz in the 
treatment of the earlier stages of gonorrlxcea, as it shortens the course 
of the disease. He suggests the following formula : 

Methylene bine 2 grains (0.13). 

Oil of sandalwood 3 " (0.2). 

Oleo-resin of copaiba 3 " (0.2). 

Oil of cinnamon 1 minim (0.06.) 

To be made in one capsule, three of which are to be taken eacb day. 

Injected into a muscle in the dose of 1 grain in 10 minims of water, 
methylene blue is used to test the activity of the eliminative function 
of the kidney. In health it should appear in the urine in fifteen to 
thirty minutes, and persist for thirty-six hours. 

The ordinary dose in the treatment of malaria is 2 to 4 grains 
(0.1-0.2) every four hours to adults, or 1 to 2 grains (0.05-0.1) to 
children of five years, preferably given in capsule. 



METHYLENE CHLORIDE. 

Methylene Chloride is made from chloroform or by the action of 
chlorine on marsh-gas, and is a colorless liquid resembling chloroform 
in odor. It is readily decomposed by light, which process may be 
hindered by the addition of a little absolute alcohol. 

Therapeutics. — This drug is employed as an anaesthetic in a manner 
like chloroform, and was introduced as a safe substitute for that drug, 
but it is of doubtful safety and is little used. It has been used as a 



316 DRUGS. 

spray for the production of local anaesthesia. As stated under Methyl 
Chloride, it is not to be confounded with that drug. 

In England, under the name of methylene chloride or methylene, 
a mixture of ethyl ether and methylene chloride has been widely 
employed by inhalation. This preparation is, of course, to be distin- 
guished from true methylene chloride. The amount of this mixture 
used to produce anaesthesia is 1 to 2 drachms (4.0-8.0) for minor and 
3 to 6 drachms (12.0-24.0) for major operations. The term " methyl- 
ene chloride " has also been applied to a mixture of chloroform and 
methyl chloride. 

MUSK. 

Musk (Moschus, U. S. and B. P.) is obtained from the preputial 
follicles of the Moschus moschiferus or musk deer of Thibet, and is a 
substance possessing the most remarkable penetrating powers, so far as 
odor is concerned. Very little of the musk for sale in the shops is 
pure, and most of it is not musk at all. Its price varies very greatly, 
but if sold for less than twenty-five cents a grain it is probably worth- 
less or impure. 

Therapeutics. — For some unknown reason musk acts as a diffusible 
stimulant and supports the system. It is also an antispasmodic and 
nervous sedative. In all low fevers where the strength of the patient 
is fast ebbing away and the nervous symptoms are those of the most 
advanced depression, rectal injections of musk in starch-water should 
be employed. The dose should be 5 to 10 grains (0.35-0.65). This 
drug is of value where either nervous excitement or nervous collapse 
is present, but is not to be employed until it is absolutely needed to 
carry the patient past a crisis. If frequently employed, it loses its 
power and the expense is a needless one. 

Musk is one of the best remedies in obstinate hiccough. 

The dose of the tincture (Tinctura Moschi, U. S.) is 40 minims 
to 1 drachm (2.0-4.0), and of musk itself 5 to 10 grains (0.32-0.65). 

MUSTARD. 

Mustard is official in the form of Sinapis alba, U. S., and Sinapis 
Albce Semina, B. P., or white mustard, derived from the seeds of 
Brassica alba, and Sinapis nigra, U. S., and Sinapis Nigra? Semina, 
B. P., or black mustard, derived from the seeds of Brassica nigra. 
Both of these contain an irritant oil (Oleum Sinapis Volatile, U. S. 
and B. P.) as their chief active constituent. 

Therapeutics. — Mustard is often used in the form of mustard flour 
as an emetic when stirred up in water in the proportion of 2 table- 
spoonsful to a glass of water. It is also employed as a counter-irritant 
and a- a condiment. If given in excessive dose, it will cause violent 
gastritis, and chronic gastritis is often set up by its constant use in 
excess. Its internal use is contraindicated during the existence of 
acnte gasi ritia and all states of gastro-intestinal irritation. 

When used as a counter-irritant mustard is applied to relieve the 



MYRRH. 317 

pain of colic due to flatulence and acute inflammation of the abdominal 
and thoracic viscera, that due to muscular rheumatism, inflamed joints, 
and neuralgia, and it may be applied at the nape of the neck in cases 
of headache and cerebral congestion. When applied to the skin of an 
ordinary individual, it will produce a bad burn if left on more than a 
few minutes, and it should be mixed with wheat flour in the propor- 
tion of half-and-half when used upon persons having tender skins. 
Children generally will not tolerate more than one-fourth mustard. 
The plaster should be made by mixing mustard flour and wheat flour 
together and then moistening the mixed flours with warm water or 
warm vinegar, or a little brandy may be used. 

The scald or burn produced by mustard is peculiar in its slowness 
to heal and in the fact that it is tender and reddened for days. Often 
it produces a permanent stain of the skin. If the burning of the mus- 
tard becomes excessive, it should be treated by applying a piece of 
lint soaked in lime-water and olive oil, half-and-half, or olive oil alone 
may be used. 

The oil of mustard is very irritant, and almost epispastic in its 
effects. It is sometimes given in the treatment of the atonic stomach of 
drunkards in the dose of \ to ^ a minim (0.016-0.03). C'harta Sinapis, 
JJ. S. and B. P., or mustard-papers, are sometimes called sinapisma, 
and these afford a ready means of applying this counter-irritant. 
They are generally very strong, and one or two layers of thin and 
moistened linen should be placed between the skin and the sinapism to 
prevent too great an action. (See Counter-irritation.) The compound 
liniment {Linimentum Sinapis Oompositum, JJ. S. ; Linimentum Sina- 
pis, B. P.) is composed of the oil of mustard, castor oil, extract of 
mezereum, and alcohol. The mezereum is omitted in the British prepa- 
ration, which is twice as strong in mustard oil as the JJ. S. P. preparation. 

MYRRH. 

Myrrha, JJ. S. and B. P., is a gum-resin obtained from Com- 
miphora Myrrha, a tree of Arabia. It occurs in dark-colored tears, 
and contains an active principle, myrrhin. 

Therapeutics. — Myrrh, in medicinal amount, is a stimulant to the 
circulation and to the uterine and the bronchial mucous membranes. 

In amenorrhoea due to functional inactivity or anosmia, " iron and 
myrrh " is a standard remedy. 

The tincture of myrrh, diluted one-half, is useful in ulcerated sore 
throat as a gargle, and the pure tincture is sometimes applied with a 
small brush or by the end of the finger to spongy or tender gums. 

In leucorrhoea depending upon uterine trouble and in chronic 
cystitis myrrh is often of service. Sometimes it enters into expec- 
torant mixtures given in the later stages of bronchitis. The dose of 
the tincture {Tinctura Myrrhm, JJ. S. and B. P.) is 10 to 30 minims, 
(0.65-2.0). It also enters into the composition of Pilulo? Aloes et 
Myrrhce, JJ. S. and B. P., dose two to five pills, and Tinctura 
Aloes et Myrrhce, JJ. 8., the dose of which is 1 to 2 fluidrachms 
(4.0-8.0). 



318 DRUGS. 

NAPHTHALIN, or NAPHTALENE. 

Xaphthalinum, TJ. S., is a coal-tar derivative occurring in color- 
less mica-like crystals, possessing a peculiar smell, and soluble in 
alcohol to some slight extent. Helbing states that naphthalin when 
pure is colorless and without action on moist litmus-paper. It should 
also dissolve in concentrated Sulphuric acid without color when gently 
warmed. After it is taken for some time, or even after the first dose, 
the patient will state that when he belches the gas has the smell and 
taste of burning rubber. 

The drug possesses distinct antiseptic power, and for this reason 
has been employed in certain gastric and intestinal diseases asso- 
ciated with fermentative changes or dependent upon ulceration and 
organic lesions. In foetid diarrhoea it may be given as a deodorant 
and cure. , 

When given to children, as in summer diarrhoea, the dose should 
De 6" to i g ra, i n (0.01-0.015) every two or four hours, but adults may 
take as much as 5 to 10 grains (0.35-0.65). More than this will dis- 
order the stomach. The drug should be given in powder, with sugar, 
or in capsule. It has not been as widely employed as was expected 
when it first came before the profession, and certainly often fails to 
do good. 

In cats and rabbits naphthalin, when administered continuously for 
a considerable period of time, produces cataract. 



NAPHTOL. 

NaphtoL TJ. 8., and Naphthoh B. P.. is often called Beta-naphtol, 
and is generally artificially prepared from naphthalin. It is used 
externally in antiseptic dressings. Internally it is an excellent 
remedy for gastric fermentation and flatulence, as it acts as an active 
antiseptic. It is also useful in foetid diarrhoea of the serous type. 
The dose is 2 to 5 grains (0.15-0.3) in capsule or cachet. 

Beta-naphtol-bismutli, or Orphol, is a neutral, odorless, and tasteless 
powder designed to combine the sedative effects of bismuth with the 
antiseptic properties of beta-naphtol. It is used in cases of serous and 
fermentative diarrhoea in adults in the dose of 5 to 15 grains (0.3-1.0) 
and in infants in the dose of 2 to 5 grains (0.1-0.3) every few hours 
in capsule. 

Benzonaphtol is used as a substitute for beta-naphtol in fermentative 
dyspepsia. The dose is about 10 grains (0.65) three times a day, and 
it is best given in cachet 

NARGOL. 

Nargol is a chemical compound of silver and nucleinic acid, which 
is readily soluble in water, and possesses a more penetrating power 
and more lasting effects than other silver preparations. It is not pre- 
cipitated by coming in contact with albuminoids, and it does not 

undergo change when boiled. Nargol contains about 10 per cent. 



NITRATE OF POTASSIUM— NITRATE OF SILVER. 319 

of metallic silver, which is more than that contained in the other 
organic silver compounds now obtainable by physicians. 

Therapeutics. — Nargol is employed in the treatment of gonorrhoea 
in the form of injections in the strength of 0.25 to 1 per cent. ; although 
in chronic cases the strength may be increased up to 5 per cent. It 
destroys the gonococcus and seems to penetrate into the crypts and 
deeper-lying tissues, and is said to produce little or no pain if not in 
too strong solution. It diminishes the discharge quite rapidly. 

By ophthalmologists it is employed in the eye in the strength of 
5 per cent, in the treatment of the various inflammations of the con- 
junctiva, but is not sufficiently strong for cases of granular conjunc- 
tivitis. It is, however, a very valuable drug in gonorrhoea! ophthal- 
mia and in ophthalmia neonatorum. It has also been employed in 
gonorrhoea! vaginitis, and as a silver ointment in the strength of 5 or 
10 per cent, with cosmoline or lanolin upon suppurating ulcers and 
bur?is. It does not possess any odor, and therefore has a great 
advantage over iodoform and similar substances which have been 
used in this manner. 

NITRATE OP POTASSIUM. 

Nitre (Potassii Nitras, TJ. S. and B. P.), or Saltpetre, occurs in 
long needle-like crystals and has a sharp, saline taste. Sal prunella 
is saltpetre melted and run into moulds. 

Next to the chlorate of potassium, this is the most poisonous of the 
potassium salts, and produces when taken in overdose symptoms of 
violent gastro-enteritis. While it does not affect the blood, it is more 
irritant than the chlorate. 

Nitrate of potassium is rarely employed at present, and has been 
very properly put aside as inferior to the harmless vegetable potas- 
sium salts (the citrate, acetate, and bitartrate). If used in rheuma- 
tism, the dose should be 1 ounce (32.0) in a pint (J litre) of barley- 
water or syrup of acacia and water, to be taken in divided doses of a 
tablespoonful every three hours. Nitrate-of-potassium papers (Oharta 
Potassii Nitratis, TJ. S.) are made by dipping unsized paper in a 
solution of the drug of the strength of 20 parts of the salt to 80 
parts of distilled water They are rolled into cigarettes and smoked 
by asthmatics, or burned in a pan and the fumes arising from them 
inhaled. Their efficacy may be increased in cases where the respira- 
tory mucous membrane is irritable by dipping them in compound tinc- 
ture of benzoin and exposing to the air long enough to dry. They 
should then be protected from the air until used. 

The paper used should be moderately thin bibulous paper. 

NITRATE OP SILVER. 

Nitrate of Silver (Argenti Nitras, TJ. S. and B. P.) is a heavy 
crystalline salt of silver readily soluble in its own weight of water. 

It is official as the pure nitrate (Argenti JS r itras, TJ. S. and B. P.) 
and as the sticks or fused rolls (Argenti JYitras Fusus, U. S.), or lunar 



320 DRUGS. 

caustic. The latter are never used in medicine internally, only the 
crystals being employed. Applied to the tissues of the body or other 
substances, nitrate of silver causes a brown and finally a black stain, 
which is due to the formation of an oxide of silver. 

Physiological Action. — Nitrate of silver is one of the few astrin- 
gent substances which are applicable to inflamed mucous membranes, 
as it is, with lead, bismuth, and zinc, one of the few drugs of this 
class which is not irritant as well as astringent. Locally applied, it 
acts in pure form as a powerful caustic, which is, however, very 
superficial in its effects, as the drug coagulates the albumin with which 
it comes in contact and thereby forms a coat which protects the tissues 
beneath. 

The action of the drug upon the circulation, respiration, and similar 
vital functions is only partly known, and has no relation to its em- 
ployment in medicine. 

Nitrate of silver is eliminated from the system very slowly indeed. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of nitrate of silver violent pain in the belly, with vomiting and 
purging, comes on. At the same time evidences of widespread gas- 
troenteritis develop. The abdominal walls are knotted and hard, 
and perhaps scaphoid. The face is anxious and livid and covered 
with a sweat. When the vomiting occurs the ejecta are seen to be 
brown or blackish, or even white and curdy. The lips are stained 
white, but they rapidly become brown, then black. In some cases the 
nervous symptoms are severe and convulsions with delirium may occur. 
The convulsions are epileptiform. Death ensues either from gastro- 
enteritis or from centric respiratory failure, accompanied by a profuse 
exudation of liquid mucus into the bronchial tubes. 

The treatment consists in the use of common salt, which is the 
chemical antidote, the employment of opium and oils to allay irrita- 
tion, and in the ingestion of large draughts of milk and of soap and 
water for the purpose of diluting the poison and protecting the mucous 
membranes of the oesophagus and stomach from the action of the irri- 
tant. The bodily heat must be maintained. 

Chronic Poisoning. — This is a form of poisoning quite frequently 
seen. The most prominent symptom is the pale slate-blue color of 
the skin, which causes the individual to be livid and death-like in 
appearance. 

Argyria, as chronic silver poisoning is called, is caused by the 
continued employment of the drug until it is deposited in the tissues. 
It is then found in every part of the body. The first signs of dis- 
coloration can generally be seen in a darkening of the conjunctiva 
over the sclerotic coat of the eye or in a dark line on the inner part 
of the lips. 

The treatment of argyria is not hopeful so far as the color of the 
skin is concerned, but the discoloration may be slightly modified in 
some cases by the use of iodide of potassium to aid in the elimination 
of the silver. 

Therapeutics. — Internally this salt is used as a cure for gastric ulcer, 
and it is certainly the best remedy we possess if combined with extract 



NITRATE OF SILVER. 321 

of hyoscyamus or opium and given in pill form. In chronic gastric 
catarrh and gastritis nitrate of silver is very useful when the patient 
is troubled with sour eructations or when vomiting occurs after meals. 
When used in these states it should be given in -jU to J-grain (0.01- 
0.16) doses, half to one hour before each meal, in order that the 
stomach may be exposed to its effects and not be protected by 
food. 

In intestinal ulceration the drug has been highly recommended by 
Dr. Pepper, and under these circumstances should be given in hard 
or keratin-coated pills, in order that it may escape through the stom- 
ach without being chemically changed. In ulceration of the ccecum 
and rectum and in acute and chronic dysentery the disease may be at- 
tacked by rectal or colonic injections of nitrate of silver. If the caecum 
is involved, the solution must be given in large quantity in order to 
reach the part affected, but if the rectum is diseased, the amount of 
liquid injected should not exceed 4 ounces, the bowel in either case 
being washed out beforehand by warm water to rid it of faeces. Soap 
and water and salt and water must not be used for this purpose, as 
the soap or salt which remains in the bowel will prevent the silver salt 
from acting. The strength of the solution employed should be 1 
drachm to 3 pints (4.0:1500 cc.) of water in caecal trouble, and 3 
grains (0.18) to each 4 ounces (120.0) in rectal trouble. If the latter 
condition is very obstinate and chronic, the strength may be increased 
to 5 grains (0.3) to each 4 ounces (120.0). 

Whenever nitrate-of-silver injections are used in this way, a solu- 
tion of salt and water should be made, ready for use, and injected if 
the action is too severe or as soon as it is thought that the drug has 
acted with sufficient thoroughness. 

Nitrate of silver was at one time thought to be of value in lateral 
and posterior spinal sclerosis, but rarely does good. 

Nitrate of silver has been largely used in epilepsy and chorea, but 
is now seldom so employed, and does little good in most cases. 

Dr. William* Pepper thought highly of the continual administration 
of nitrate of silver in pill form in the dose of \ to J- grain (0.01- 
0.015) through the entire attack of typhoid fever, and believed that 
it greatly modified the severity of the disease. 

Externally, nitrate of silver is used for many purposes, and will 
often prevent the pitting of small-pox if on the fourth or fifth day the 
vesicles are punctured by a needle dipped in a solution of nitrate of 
silver in the strength of 20 grains (1.3) to the ounce (30.0) of water. 
Others simply paint the skin over the eruption with a solution of 
5 to 10 grains (0.32-0.65) to the ounce (30.0), claiming that this 
method is equally effective and prevents inflammation and sup- 
puration. 

Higginbottom has highly recommended the use of nitrate of silver 
upon erysipelatous inflammations, but the practice is not often resorted 
to, and is now supplanted by better measures. (See Erysipelas.) In 
other inflammations of a superficial character nitrate of silver is of 
great value. Painted in strong solution over the scrotum in the early 
stages of orchitis or epididymitis, it will often relieve the pain and 

21 



322 DRUGS. 

swelling, and felons may sometimes be aborted by its early application 
in concentrated solution over the surface of the finger. 

In all inflammations of the pharynx, larynx, fauces, and mouth 
solutions of silver nitrate are to be used in varying strength. Some- 
times after slight exposure to cold or dampness the posterior wall of 
the pharynx suddenly becomes sore and raw, feeling as if the mucous 
membrane had been scarified. A solution of nitrate of silver will 
relieve this, and if it is employed in the strength of 60 grains (4.0) 
to the ounce (30.0) of water, the application will be more efficacious 
and less painful than if weaker solutions are employed. 

In laryngeal phthisis a spray used from an atomizer in the strength 
of J to 2 grains (0.03-0.1) to the ounce (30.0) of water may do good 
service. 

In whooping cough Ringer recommends the use of a spray in the 
strength given above for the purpose of relieving the cough in its vio- 
lence and frequency and of obtaining a good night's rest. The appli- 
cations should be made when the stomach is empty, as they are apt to 
bring on retching. The end of the atomizer must be within the 
mouth or the skin of the face will be stained. 

In the later subacute stages of gonorrhoea an injection of nitrate 
of silver of the strength of gr. \ (0.025) to 3 ounces (90.0) of water 
is very useful. (See Gonorrhoea, Part IV.) 

In uterine ulceration and in leucorrhoea when the cervix is boggy 
and tender, the application of the solid nitrate-of-silver stick is of 
service. Its use is often followed by headache about the vertex, and 
this in turn is to be relieved by 10-grain (0.65) doses of the bromides. 

In pruritus pudendi vel ani and vulva? a solution of 4 to 6 grains 
(0.25-0.40) to the ounce (30.0) should be painted with a camel's-hair 
brush over the parts to relieve, the itching. The application is to be 
made from two to four times a day. 

Bed-sores may be aborted if, as soon as the skin reddens, a solu- 
tion of nitrate of silver of the strength of 20 grains (1-3) to the ounce 
(30.0) is applied with a brush to the part. This measure often fails in 
paralytics for obvious reasons. 

Boils which begin in a small limited papule with a surrounding 
area of inflammation may sometimes be aborted by painting a strong 
solution of this salt around them. 

In granular lids, conjunctivitis, and similar affections about the eye 
nitrate of silver in stick form or in solution is largely and success- 
fully employed. (See Conjunctivitis.) 

When it is desired to remove nitrate-of-silver stains, they should 
be washed with a solution made of cyanide of potassium 2J drachms 
(10.0). iodine 15 grains (1.0), and water 3 ounces (90.0); or dissolve 15 
mains (1.0) corrosive sublimate in 7 ounces (200.0) of boiled water, 
add about 45 grains (3.0) of cooking salt (a scant teaspoonful) just 
before using, lay the stained materials in it for about five minutes, and 
then wash them two or three times. 

Administration. — The dose of nitrate of silver is -J- to J of a grain 
(0.01-0.015) in pill form. Mitigated caustic, or diluted nitrate of 
silver {Argenti Nitras Dilutus, U. >S. ; Argenti Nitras Mitigatus, 



NITRIC ACID. 323 

B. B.), is composed of equal parts of nitrate of silver and potassium 
nitrate, and is used as a mild caustic. 

The drug when given continuously should be discontinued for two 
weeks at the end of the eighth week, as it is so slowly eliminated as to 
accumulate in the body and cause argyria, but Lewin and Soullier as- 
sert that the smallest aggregate amount on record which has produced 
argyria is 1 ounce. 

NITRIC ACID. 

Nitric Acid (Acidum Nitricum, U. S. and B. P.), the strongest 
and most corrosive of the mineral acids used in medicine, is a clear 
liquid, becoming slightly yellow with age. It should be kept in dark, 
glass-stoppered bottles. 

Physiological Action. — Nitric acid acts, when in pure form, upon 
the tissues of the body as a powerful caustic. Applied to the mucous 
membranes, well diluted, it acts as an irritant or astringent, and when 
taken internally it exerts a stimulating influence over the secretory 
glands of the stomach and small intestines. It does not tend to relax 
the bowels, as does nitro-hydrochloric acid. Continued for a long 
period of time in small doses, it is said to cause some salivation and 
looseness of the teeth. Nitric acid coagulates albumin. 

Poisoning. — When nitric acid is taken in concentrated form it pro- 
duces a widespread gastro-enteritis, great pain in the mouth, oesoph- 
agus, and abdomen, and finally death, from the inflammation induced 
or from collapse. If the patient survives the acute stages, he may 
die from secondary changes in the stomach and bowels, such as stric- 
ture or destruction of the peptic tubules. The stain made by the acid 
about the mouth and clothes is deep lemon-yellow. Renal irritation 
is often a severe symptom, and the passages from the bowels and the 
urine may be bloody. 

The antidotes are any alkali of a mild type, as magnesium, chalk, 
or whitewash from the walls of the room, the use of oils and opium to 
relieve irritation, and the proper maintenance of bodily heat. 

Therapeutics. — Nitric acid is used externally in medicine as a 
caustic for chancres and chancroids, the surrounding tissues being 
protected by oils or ointments. 

It may also be used on ivarts, in cases of gangrene to destroy the 
tissues, and on phagedenic ulcers. Whenever the acid is to be applied 
for such purposes, a solution of soap and water should be at hand to 
neutralize its effects as soon as it has acted deeply enough. Nitric 
acid is also used externally in a dilute form, 5 to 30 minims (0.35- 
2.0) to the ounce (30.0), as a stimulant and astringent to indolent 
ulcers. 

Internally, nitric acid is used as a tonic and astringent. In the 
oxalic-acid diathesis when oxaluria is present, nitric acid will give 
relief when nitro-muriatic acid cannot be obtained, although the latter 
is preferable. When small ulcers exist in the mouth or stomatitis is 
present, 3 minims (0.25) of nitric acid at a dose, in water, will often 
be of service, but it should be taken through a tube to protect the teeth. 
In gastric indigestion in which, sometimes after a meal, undigested 



324 DRUGS. 

food regurgitates into the mouth, a few drops of nitric acid given in 
water after meals will often give relief. In intestinal dyspepsia 
coming on some hours after meals, and in which not only discomfort 
but pain ma} T be felt in the hypochondrium, nitric acid with some 
bitter tonic is most efficient, and it will often cure the green diarrhoea 
of children, particularly that met with in summer, bringing about these 
changes not only by its astringent power, but also by its stimulating 
effect on the intestinal glands. Combined with some good pepsin, it 
will give relief in the chronic diarrhoea of children associated with 
lientery, and in which the stools may be pasty or watery and at the 
same time ill-smelling. 

Ringer recommends the employment of nitric acid in the treat- 
ment of piles. The strong acid should be used, and simply touched 
to one or two points, not swept over the whole surface. The pain is 
very slight, or none at all may be felt. A slough results, and finally 
comes away, leaving a cicatrix which as it contracts diminishes the 
size of the pile. 

The same author also states that a lotion of dilute nitric acid in 
the proportion of \ to 1 drachm (2.0-4.0) to a pint (500 cc.) of water 
is of service in bleeding hemorrhoids, arresting the bleeding, con- 
stringing the parts, and relieving the sensation of weight and fulness 
so often a pressing symptom. 

The dose of dilute nitric acid '{Acidum Nitricum Dilutum, U. S. 
and B. P.) is 3 to 15 minims (0.25-1.0), well diluted, and taken 
through a tube to protect the teeth. 

An exceedingly strong preparation, Acidum Nitricum Fumans, is 
official in the B. P. 



NITRITE OP POTASSIUM. 

Nitrite of Potassium is a salt used largely in modern medicine to 
take the place of nitrite of amyl, but it possesses greater stability, and 
is, therefore, more permanent in its effects. It is used for the relief 
of angina pectoris or heart-pa7ig, in the treatment of gastralgia, and 
even in epilepsy. The dose is from 3 to 5 grains (0.25-0.3), although 
much larger doses have been employed. These larger doses are, how- 
ever, not devoid of danger. Nitrite of potassium is eliminated by the 
lungs and by the kidneys as a nitrate. (See Nitro-glycerin.) 



Cobalto-nitrite of Potassium. 

This preparation has been suggested and tried successfully as a sub- 
stitute for the nitrite of potassium. As it is a more stable compound, 
it is less rapidly broken up in the system, and so exercises a more pro- 
Longed influence. For this reason it does not act so vigorously or 
suddenly, which is a great advantage in some cases. It use is iden- 
tical with that of the rest of the nitrite group. The dose of cobalto- 
nitrite of potassium is \ grain (0.03) every three hours. 



NITRITE OF SODIUM— NITRO-GLYCERIN. 325 

NITRITE OP SODIUM. 

Sodium nitrite (Sodii Nitris, B. P.) is used for the same purposes 
as nitrite of potassium in the dose of 1 to 2 grains (0.05-0.1) given in 
pill or cachet. 

NITRO-GLYCERIN. 

Nitro-glycerin, sometimes called trinitrin or glonoin, is a com- 
pound which, in its pure state, is used largely as an explosive, but it 
is employed in medicine in a dilute form as a useful drug in those 
instances where a somewhat rapid and powerful effect is to be exercised 
over the vascular system. As its influence lasts but a short time, it 
should be given every three or four hours. . Its physiological action is 
identical with that of the other nitrites, such as the amyl nitrite (which 
see), except that it is not so violent or fugacious as the latter nor so 
persistent in its effects as the nitrites of sodium and potassium. The 
dose is 1 to 2 minims (0.06-0.12) of a 1 per cent, solution in a little 
water or in a pill, and no more than this may be employed at one dose 
unless the patient takes the remedy for a considerable period of time, 
when as much as 60 minims may be administered. Often good results 
are obtained only by giving ascending doses. It is noteworthy that 
patients rapidly become immune to the drug, and Reading has 
recorded a case in which, after a year of treatment, 1 drachm (4.0) 
of a 10 per cent, solution was taken daily with good effect. D. D. 
Stewart has also reported similar cases. The drug is largely em- 
ployed in angina pectoris (see Part IV.), and sometimes in epilepsy 
and chorea and in gastralgia. DaCosta and others have highly 
commended this drug in the treatment of chronic parenchymatous 
nephritis, as it very distinctly decreases the escape of albumin from 
the kidneys. In interstitial nephritis, with cardiac disturbance re- 
sulting from the renal changes, in which there is a marked increase 
in arterial pressure, so that auscultation reveals at the second right 
costal cartilage an accentuated second sound due to the forcible 
closure of the aortic leaflets, nitro-glycerin often produces a good 
effect by reducing the pressure and relieving the heart of strain. 
This use of the drug is its most important application. (See article 
on Heart Disease, in Part IV.) It is when attacks of angina pectoris 
seem to be accompanied or preceded by marked vascular spasm that 
nitro-glycerin is chiefly indicated. In cases of asthma dependent 
upon spasm and engorgement of the mucous membranes of the 
bronchial tubes it is very serviceable. Humphreys asserts that nitro- 
glycerin is a most valuable drug in vomiting of all kinds, except 
that of pregnancy and peritonitis. Given in the dose of ^-J-g- grain 
(0.0003) hypodermically with morphine it prevents the after-nausea 
usually produced by opiates. Nitro-glycerin usually causes a con- 
siderable increase in urinary flow by reason of the relaxation of the 
renal blood-vessels which it produces, particularly in Bowman's capsule. 

The watery solution used in medicine is too weak to be explosive. 
Tablets of nitro-glycerin (Tabelloe Trinitrini, B. P.) each contain 
Tiro of a g rain (0.0006). The U. S. P. of 1890 introduced a Spiritus 



326 DRUGS. 

Grlonoini, which is an alcoholic solution of glonoin. It should be 
kept in tightly-stoppered tins, never in glass, and be stored in a cool 
place, away from heat. Its explosiveness is in direct ratio to the 
evaporation of its alcohol. The dose of the spirit is the same as that 
of the watery solution — namely, 1 to 2 minims (0.05-0.1). Liquor 
Trinitrini, B. P., is practically identical with the spirit just named, 
and is given in the same dose. 

BRYTHROL TETRANITRATE. 

This is a white crystalline substance, soluble in alcohol, but in- 
soluble in water. It is explosive on percussion or trituration, and 
is employed in the place of nitro-glycerin for the purposes just named. 
It is not as useful, however. Its dose is J to J- grain (0.015-0.03), 
given in solution or in tablets. 

NITRO-HYDROCHLORIC ACID. 

Xitro-hydrochloric Acid (Acidum Nitro-liydrochloricum, U. S.) is a 
liquid giving off a distinct odor, and possessed of a very caustic power, 
staining the tissues of the body a light yellow. It is official in the 
form of the dilute acid (Acidum Nitro-hydrochloricum Dilutum, XI. S. 
and B. P.), in which form it is useless except as an ordinary acid. 
When we wish to use the acid for its own peculiar effects, the official 
dilute acid ought always to be supplanted by the freshly-mixed strong 
acid and be of an orange color. If this cannot be obtained, the physi- 
cian should prepare the compound for himself by adding 4 parts of 
medicinally pure nitric acid to 16 parts of hydrochloric acid, and 
allowing the mixture to stand in an open bottle until the fumes are no 
longer given off in excess, when it must be tightly corked and kept 
in a dark place. This acid ought to be freshly prepared every few 
days. 

Poisoning. — The symptoms caused by poisonous doses are those of 
violent gastro-enteritis with vomiting and purging of bloody materials. 
Death may occur from perforation of the alimentary canal, from inflam- 
mation of the abdominal viscera, and from destruction of the peptic 
tubules or constrictions of the oesophagus or bowel. The treatment 
consists in the use of alkalies, such as magnesium, lime, whitewash, 
soap, and oils, with opium to allay irritation. The use of external heat 
to prevent collapse is also to be resorted to. 

Therapeutics. — Nitro-hydrochloric acid is an invaluable remedy in 
many cases of indigestion arising either in the stomach or bowels, as 
it acts as a tonic and stimulant to secretion. Upon the biliary flow 
its action is quite marked, and it may even cause bilious purging if 
administered in full doses for some days. It is therefore largely used 
in hepatic torpor, either acute or chronic, and in the early stages of 
hepatic cirrhosis should always be resorted to. In the chronic hepatitis 
of hot climates it is exceedingly useful, but it is not to be employed in 
acute sthenic hepatitis, as it is a stimulant to the liver, which, under 
these conditions, needs quieting. When used in chronic hepatitis it 
should be given in full dose and pushed to its physiological limit, as 



NITROUS OXIDE. 327 

evidenced by the bilious purging produced or by signs of gastrointes- 
tinal irritation. 

A useful additional means for obtaining the beneficial effects of 
this acid is to use it by means of the foot-bath or general bath. As 
used by Johnson in India, the acid for this bath is prepared by slowly 
and carefully adding together 2 parts of nitric acid, 3 parts of hydro- 
chloric acid, and after twenty minutes mixing carefully with these dis- 
tilled water 5 parts. For the general bath (in a wooden tub) take 5 
pailfuls of water, 64 fluidounces (2 litres +) of the acid mixture, and 
enough boiling water to raise the temperature to 98°. Keep the 
patient in the bath twenty minutes. Then rub him thoroughly with 
warm towels and place him in a dry, warm bed. For the foot-bath 
add 6 ounces (180.0) of the acid to 2 gallons (7 litres) of water at 
98°, and bathe the thighs and calves of the legs for twenty minutes 
with a sponge wet with the mixture. This is a very useful treatment, 
according to Stille, for cases of alcoholic hepatic torpor. If in either 
case the skin becomes irritated less acid is to be used. 

In ordinary so-called biliousness, which is not biliousness, but 
intestinal indigestion, this acid is often of great service. (See Indi- 
gestion and Biliousness.) It is also of value in lienteric diarrhoea 
where the dysentery results from defective secretory action on the 
part of the glands which pour out the proper fluids for digestion. 

Another very important action of nitrohydrochloric acid is the re- 
medial influence it exerts in cases suffering from oxaluria, particularly 
if this be associated with melancholia or great depression of spirits. 

Administration. — The strong freshly-mixed acid should be given 
to the adult in the dose of 1 to 3 minims (0.05-0.18) three times a day, 
well diluted, and taken through a tube, after meals. If the patient is 
intelligent, he should be ordered -^ ounce (15.0) of the pure acid and 
told how to drop it. If he is not, the physician must order it partly 
or entirely diluted in the prescription, and in so small an amount 
that it will be renewed before it loses any of its power. Warning 
should be given of its effects on any clothes with which it may come 
in contact, and care should be taken that the bottle is held some dis- 
tance away from the face when the cork is withdrawn, as the acid, if 
it is fresh, may spurt out and burn the eyes and face. 



NITROUS OXIDE. 

Nitrous oxide or nitrogen monoxide is sometimes called protoxide 
of nitrogen or "laughing gas." Its power of relieving pain was first 
recognized by Sir Humphrey Davy about one hundred years ago. 
As with ether, so with nitrous oxide, its first use as a surgical anaes- 
thetic was by an American, Horace Wells, a dentist. 

This gas is obtained by a complicated process which requires the 
use of such cumbersome apparatus that its manufacture is out of the 
question for the ordinary practitioner of medicine, while the fact that 
several large firms prepare the gas and sell it in cylinders ready for use 
renders its preparation on a small scale unnecessary. The gas is devoid 



328 DRUGS. 

of odor, but possesses a slightly sweet taste. It may be kept in gase- 
ous form or liquefied and allowed to become gaseous as it is used. 

Physiological Action. — Owing to the symptoms sometimes produced 
in patients inhaling this gas, it has received the popular name of 
"laughing gas," but a condition of hilarity is rarely seen when the 
inhalations are full and deep, and only comes on in the majority of 
cases where the gas is taken in small amounts or very slowly. When 
used properly, the patient is directed to take long, deep inspirations 
from the tube placed in the mouth, the nose being held so that the nos- 
trils are closed. Under these circumstances the face becomes for a 
moment flushed, then of a deadly pallor, and finally the jaw drops if 
the effect is very great. At this time anaesthesia is complete and the 
operation is to be rapidly performed. Owing to the fact that when pure 
it is devoid of irritant properties, this gas can be used when ether and 
chloroform are contraindicated. 

According to some careful studies upon the action of this gas 
(Kemp), it has no direct effect on the heart and vasomotor system, but 
indirectly it causes a rise of arterial pressure by the slight asphyxia 
which is produced. The anaesthesia may be clue in part to the 
non-oxygenation of the blood during the time the gas is in this fluid, 
but the gas produces anaesthesia aside from any such influence by a 
direct action on the cerebral cortex. It is a curious fact that the 
conjunctival reflex is often preserved after general anaesthesia is 
present, It has been thought that the use of this drug produces 
temporary glycosuria, but recent studies render this doubtful, to say 
the least. Where permanent glycosuria has been produced some 
injury to the vascular system in the region of the diabetic centre in 
the floor of the fourth ventricle has in all probability occurred. 
Nitrous oxide gas when inhaled very rarely produces any disagree- 
able after-effects, save a little light-headed sensation or dizziness for 
a few hours. 

Therapeutics. — Nitrous oxide is a useful anaesthetic in all minor 
operations, such as opening an abscess, boil, or felon, or even ampu- 
tating a thumb. It is used by many surgeons at the present time 
for the purpose of beginning an anaesthesia which is to be continued 
by ether or chloroform. The gas possesses two disadvantages, the 
first of which is its brevity of action ; the other, the difficulty in 
carrying it from place to place. It possesses a great advantage in 
almost absolute safety, very few deaths having been caused by it 
directly. It is the safest of all anaesthetics, not even excepting 
cocaine, which latter drug has largely supplanted the gas for many 
minor surgical operations. When teeth are to be extracted, a plug 
or cork is placed between the jaws before the gas is given, to keep 
them apart. The cork should always be attached to a string, so that 
if it slips into the back part of the mouth it can be withdrawn before 
it chokes the patient. 

Oxygen gas may be combined with nitrous oxide gas with as great 
advantage as with the vapor of ether or chloroform, although its use 
may delay to a slight extent the development of anaesthesia. The fol- 
lowing classes of persons, according to Hewitt, do better with the mix- 



NOSOPHEN — NUCLEIN. 329 

ture of oxygen and nitrous oxide than with the nitrous oxide alone : 
1. Children (who with nitrous oxide alone are liable to inconvenient 
jactitation) ; 2. Anaemic and debilitated patients, who, like children, 
quickly exhibit muscular contractions, and, in addition to this, remain 
but a very short time under the influence of nitrous oxide alone ; 3. 
Any one who has previously exhibited great susceptibility to nitrous 
oxide per se (such patients are difficult subjects to manage in dental 
practice because of the short period of available anaesthesia) ; 4. Patients 
who, under nitrous oxide alone, have experienced highly unpleasant 
sensations ; 5. Patients very advanced in years ; 6. Patients with very 
large tonsils ; 7. Patients suffering from heart or lung affections. 

Contraindications. — The gas ought not to be given to those who 
are advanced in years or have atheromatous blood-vessels, since the 
rise of arterial pressure consequent upon the asphyxia may rupture 
a cerebral blood-vessel and thereby cause an apoplexy. 

NOSOPHEN. 

Nosophen is a substance obtained by the action of iodine on solu- 
tions of phenolphtalein, and is a light impalpable powder, without 
taste or odor, and of a yellowish-gray color. It is said to contain 61.7 
per cent, of iodine. Nosophen is insoluble in nearly all solvents, but 
is soluble in alkaline solutions, and with alkalies it forms salts. The 
uses of this substance are practically identical with those of iodoform 
in that it exercises a favorable effect on tissues by reason of its iodine 
and drying properties. Its bulk is four times greater than an equal 
weight of iodoform. When used as an antiseptic on sores it should be 
brought directly in contact with the living tissue, and not simply applied 
to the pus or scab covering the part. As it will stand a high heat, it 
can be sterilized by exposure up to 220° F. without decomposition. Its 
lack of odor is a great advantage in its use. 

NUCLEIN. 

The animal body has several methods of protecting itself from the 
attacks of infecting micro-organisms. One of these is by phagocytosis * 
or the devouring of the germs by the cells of the body ; the other is by 
the protective or germicidal influence of the blood-serum. It has been 
proved that the latter power depends upon the presence in the blood 
of certain proteid-like bodies rich in phosphorus, which can also be de- 
rived from cell-nuclei and other sources, such as yeast-cells and many 
animal tissues. Nuclein is a weakly acid body composed of nucleic 
acid and some form of proteid matter, and it not only increases the 
germicidal power of the blood-serum when it is given to man or one 
of the lower animals, but in addition it causes a great increase of leu- 
kocytosis, which of course aids in phagocytosis and probably results in 
the production of still more nuclein from the leucocytes. 

Nuclein, as placed upon the market, is manufactured, as a rule, from 
yeast. It is prepared in many different ways and much of it is unreli- 
able and possesses none of the characteristics of true nuclein. Very 



330 DRUGS. 

recently Chittenden of Yale University has analyzed the various nu- 
clein preparations on the market ; and he finds a preparation called 
u nuclein standard" to contain no phosphorus, and, as phosphorus is a 
prominent constituent of nuclein, he says it " seems obvious that the 
solution contains no nuclein." "Protonuclein," another preparation 
of this character, contained 1.25 per cent, of phosphorus, and therefore 
contains in all probability nuclein, and the improved nuclein solution 
of Parke, Davis & Co., which is a 1 per cent, solution of pure nucleinic 
acid from yeast, contained 6 per cent, of phosphorus, "which would 
imply the presence of even more than 1 per cent, of such a nucleic 
acid" (Chittenden). It is evident, therefore, that this preparation of 
nuclein is a good one to use in testing this method of treatment. 

Therapeutics. — Xuclein is used with asserted great success in the 
treatment of the ordinary forms of pulmonary tuberculosis and for 
septicaemia. Theoretically it should prove useful in combating any 
infectious process. 

Administration. — The proper w r ay to use the nuclein solution just 
named is to give 10 to 60 minims (0.65-4.0) hypodermically once, 
twice, or thrice a day under careful antiseptic precautions ; or to give a 
teaspoonful (-4.0) in a wineglassful of water on an empty stomach thrice 
during the day and at bed-time. Capsules which contain 2 grains 
(0.10) of nucleinic acid may also be used. 

Contraindications. — The nucleins should not be given for a long 
period of time to gouty persons ; these patients usually have uric-acid 
troubles under their use, as nuclein is an antecedent of uric acid. 



NUTMEG. 

Myristica, U. 8. and B. P., or Nutmeg, is the kernel of the seed 
of Myristica fragrans, an East and West Indian plant, mace being 
the outside covering of the same. Kutmeg is a soporific and nervous 
sedative, exercising a peculiar influence over the cerebrum. It is 
also used as a flavoring substance in somnifacient mixtures, and is of 
value in prescriptions for serous diarrhoea. The oil (Oleum Myris- 
ticce, U. S. and B. P.) is given in the dose of 1 to 3 minims (0.05- 
•0.15). The spirit or essence (Spirit us Myristicce, U. S.) is used in 
the dose of 1 to 2 fluidrachms (4.0-8.0). 

Several instances of poisoning by nutmeg are reported; a severe 
case by Dr. Reading, of Woodbury. N. J. The symptoms closely re- 
semble those produced by excessive doses of cannabis indica. 



NUX VOMICA. 

Nux Vomica (U. S. and B. P.) is the seeds or beans of the Strych 
nos Xttc-vomica, an East Indian tree. It contains two alkaloids, 
strychnine and brucine, and depends largely for its medicinal power 
on the former. For this reason the statements made in regard to the 
physiological action of strychnine may practically be considered as 
applicable to the entire drug. 



NUX VOMICA. 



331 



Fig. 50. 




Physiological Action. — When strychnine is given to man or the 
lower animals in full medicinal dose it increases reflex activity, res- 
piratory rate, pulse-force, arterial press- 
ure, the acuity of smell, vision, and hear- 
ing, and causes general systemic irrita- 
tion or excitement. 

Nervous System. — On the nervous 
system strychnine exerts its chief influ- 
ence. It excites the spinal cord in its 
motor tracts, and probably increases the 
receptive activity of the sensory centres. 
It also has some slight influence in in- 
creasing the conductive power of the 
motor and sensory nerves. 

In overdose strychnine produces spi- 
nal or tetanic convulsions by an action 
exerted on the spinal cord. When enor- 
mous doses are given intravenously, total 
paralysis, resembling that caused by cu- 
rare, precedes the convulsions, and if 
artificial respiration is not used the ani- 
mal dies from failure of respiration. If 
death takes place from the effects of the 
drug, the motor nerves are found to be 
depressed, partly as the result of the 
poisonous action of the strychnine, and 
partly as the result of the exhaustion of 
the nerve-trunks by the convulsing im- 
pulses which they have carried (Fig. 50). 

Circulation. — Nux vomica increases 
the force of the pulse-beat and the pulse- 
rate by a stimulation of the heart-muscle 
and its ganglia, while the rise of arterial 
pressure which it causes is due to stimu- 
lation of the vasomotor centre. If very 

poisonous doses are injected intravenously, a fall of arterial pressure 
occurs instead of a rise, which is due to vasomotor depression and 
paralysis. 

Respiration. — Strychnine is one of the most constant and pow- 
erful stimulants to the respiratory centre that we have, and it not only 
increases the rate, but also the respiratory capacity. 

Temperature. — Ordinary doses have no effect upon temperature, 
but poisonous doses may raise it by reason of the convulsions. 

Elimination. — Strychnine is eliminated from the body by the 
kidneys as strychnine and strychnic acid. Most of it is oxidized and 
destroyed by the liver. 

Poisoning. — When a poisonous dose of strychnine is taken, it acts 
either suddenly or gradually. If suddenly, the man or animal may 
be, without any premonition, thrown several feet and become rigid 
by contraction of his muscles. If the onset is gradual, some stiffness 




A, Nux vomica stimulates the motor 
tracts in the spinal cord and to a 
slight extent the nerve-trunks ; B, 
in large, poisonous doses it de- 
presses the motor nerve plate in 
the muscle and exhausts the 
nerve-trunks. 



332 DRUGS. 

at the back of the neck and uneasy startings may precede the gen- 
eral nerve-storm. 

The convulsions are tetanic, or, in other words, tonic, and the 
body is thrown into opisthotonos ; that is, resting on the head and 
heels at each convulsion. Rarely the trunk is twisted sidewise or the 
flexion of the body is forward (emprosthotonos). The eyes are open 
and fixed, the corners of the mouth drawn back into risus sardonieus, 
and respiration during a severe convulsion is impossible, owing to 
the respiratory muscles being in a state of tetanic rigidity. 

The slightest noise, draught of air, or touch may cause a convul- 
sion or convulsion after convulsion, because the sensory impulse, 
reaching the spinal cord, causes a spasmodic motor impulse to be sent 
out to the muscles. 

The convulsions are not absolutely continuous, but periods of utter 
or partial relaxation occur, during which the patient breathes easily. 
The cramp-like contractions of the muscles are exceedingly painful, 
and the patient either dies of cramp asphyxia — that is, through fail- 
ure of respiration because his chest-muscles are locked in spasm — 
or, much more rarely, from exhaustion. Reichert has shown that 
it requires five hundred times the ordinarily fatal dose of strych- 
nine to cause death in animals if artificial respiration is properly 
maintained. The average fatal dose for an adult is 1^ to If grains 
(0.10-0.12). Death has occurred from \ a grain (0.03) and recovery 
after swallowing 19 grains (1.25). 

Treatment of Poisoning. — The attendant should give at once, if no 
symptoms have yet appeared, inhalations of nitrite of amyl, and mean- 
while employ the stomach-pump, using the nitrite to prevent any con- 
vulsive tendencies during the operation. Draughts of water contain- 
ing tannic acid, as the chemical antidote, are to be administered, and 
after the stomach is washed out 60 grains (4.0) of bromide of potas- 
sium and 20 grains (1.3) of chloral in solution are to be given. 
These are the physiological antidotes, for the bromide of potassium 
depresses the sensory tracts of the spinal cord, and the chloral depresses 
the motor tracts. If the convulsions prevent swallowing, the patient 
must be chloroformed with care, and the physiological antidotes given 
in starch-water by the rectum, muscular relaxation being maintained 
by the anaesthetic until the drugs are absorbed. Ether cannot be used 
as a relaxant, as it is too irritant and too slow. Nitrite of amyl is 
a physiological antidote, but it is useless if a complete convulsive 
attack is present, as it cannot be inhaled if the chest is immovable. 
Neither can any other relaxant, such as chloroform, be used under 
these circumstances. These drugs should be gently given between the 
paroxysms. If relaxation does not occur, the nitrite of amyl should 
be injected hypodermically. 

While a light touch may produce a spasm, it is said that a firm, 
hard grasp of the limb often relieves the pain of the cramp. Sensa- 
tion and consciousness are preserved in strychnine poisoning unless 
the asphyxia obtunds them. 

Differential Diagnosis. — 'Die convulsions of strychnine poisoning 
do not resemble epilepsy, because they are so distinctly tonic and 



NUX VOMICA. 333 

never clonic. From tetanus strychnine poisoning is to be separated 
by the fact that in tetanus the locking of the jaws comes first, while 
in strychnine poisoning it comes last. The convulsions of tetanus 
rarely, if ever, completely relax, while those of strychnine do have 
periods of relaxation. There is a different history in each case — in 
one perhaps of an injury, as of a nail run into the foot ; in the other, 
of a dose of poison having been swallowed. 

The differential diagnosis of strychnine poisoning from hysterical 
convulsions is more difficult. The convulsions are rarely so persist- 
ently tonic in hysteria, and the peculiar expression of the hysterical 
face is often seen in such cases. The history of the patient, if obtain- 
able, will throw much light on the case and aid very materially in the 
separation of the two conditions, while the peculiar variations in 
cutaneous sensibility, such as areas of hyperesthesia and anaesthesia, 
which are so characteristic of hysteria, may render the diagnosis pos- 
sible. 

As the treatment of all these states is virtually identical, the 
employment of the measures just suggested may be resorted to in 
each instance, and the diagnosis made afterward. 

Therapeutics. — Nux vomica, or its chief alkaloid strychnine, is 
used for several purposes in medicine. Owing to its bitter character- 
istics it may be employed as a simple bitter tonic or as one especially 
influencing the nervous system. It may also be used as a respiratory, 
cardiac, and ocular stimulant. 

In cases of functional nervous atony, or depression, strychnine 
does good, but in organic disease of the nervous system, if used during 
the period of acute inflammation, as soon after an apoplexy or in acute 
infantile palsy, it is distinctly harmful. Some persons who have 
suffered from apoplexy can never take the drug without a spasm com- 
ing on in the paralyzed part or parts, probably through irritation of 
the probably degenerated pyramidal tracts. In acute or subacute 
neuritis strychnine ought never to be used, as the nerves are already 
inflamed, and are not to be still further irritated by the employment of 
nerve excitants. In progressive lead palsy large doses of strychnine 
should be constantly used to stop the progress of the disease, iodide 
of potassium also being employed to cause the elimination of the lead. . 

In amaurosis dependent upon the excessive use of tobacco or alco- 
hol strychnine is almost a specific, and in eye-strain resulting from 
insufficiency of the ocular muscles it does great good, curing the insuf- 
ficiency and improving the general condition of the muscles. Accord- 
ing to de Schweinitz, the patient should use ascending doses of the 
tincture of nux vomica, beginning with 3 minims (0.15) three times a 
day, and increase the amount 2 minims (0.1) a day until distinct 
physiological effects are produced. Sometimes 60 minims (4.0) may 
be taken in twenty-four hours. Recent experiments made by the 
author indicate that constantly increasing doses, instead of decreasing 
the person's susceptibility to the drug, actually increase it, so that a 
moderate dose produces greater effects after some days of use than 
a full dose does at the start. 

In pneumonia and all other acute diseases in which sudden collapse 



334 DRUGS. 

is liable to occur strychnine is of the greatest service at the time of 
need. Often it will pull the patient out of a sinking attack which 
seems certain to end in death. It should be used freely by the hypo- 
dermic needle, and is often aided in producing its good effects by the 
addition of yl-g- to y-J-g- grain (0.0004-0.0006) of atropine to each injec- 
tion. (See Pneumonia and Shock.) 

The author desires to protest most emphatically against the common 
practice of the day, which consists in the use of strychnine as a circu- 
latory stimulant through prolonged exhausting illness. It is essentially 
a whip to the flagging heart, to be used at a crisis, but not continued 
for days. Cases are constantly seen in which the persistent use of 
the drug in fever produces a rapid running pulse and great nervous 
irritation and prolongation of the febrile movement. 

There is no drug known which is so antidotal to the effects of over- 
doses of chloroform as is strychnine. In cases of sudden accident, with 
arrest of the heart or respiration during the use of this anaesthetic the 
physician should give a hypodermic injection of -^ grain (0.006) of 
strychnine as a powerful, rapidly-acting cardiac and respiratory stimu- 
lant, which dose may be repeated in ten minutes if no effect is produced. 
Strychnine is a very valuable remedy in surgical shock, and is a better 
antidote to opium than is belladonna. 

In dyspnoea from any cause, such as that of old persons suffering 
from ivinter cough or bronchorrhoea, in emphysema, phthisis, and in 
shortness of breath, strychnine is of service, and it is a valuable drug 
for the treatment of opium-poisoning, because it preserves the reflexes 
and stimulates the respiratory centre. 

In atony of the bowels strychnine is of service, and it is to be added 
to purgative pills to avoid their depressing after-effect on the intestines. 

In cases of hemiplegia, strychnine may be used to keep up the 
nutrition of the limbs which are paralyzed ; but if the paralysis be due 
to disease of the trophic cells in the spinal cord, it does little good 
except to stimulate the remaining cells to greater effort. 

According to Ringer, sick headaches, due to errors in diet and 
without much nausea, can be put aside for the day by the use of 1 
minim (0.05) of the tincture of nux vomica in a teaspoonful (4.0) of 
water every five or ten minutes until 10 minims (0.65) are taken. 

Strychnine possesses no curative properties in chronic alcoholism. 
Owing to its powerful stimulant properties it may temporarily brace 
the nervous system, but its prolonged use is dangerous. It should 
be employed temporarily only to combat great depression of the system. 

Untoward Effects. — Care should be exercised in giving strychnine 
to children, as they are more susceptible to the drug than are adults. 
The proper beginning dose of strychnine by the mouth for a child of 
five or six years is not more than y^- grain (0.0006). In some cases 
of exhausting disease the prolonged use of full doses of strychnine may 
produce a talkative delirium with great peevishness, and, if the drug is 
continued, this condition may pass into a state of temporary insanity. 
Brunton asserts that nux vomica may induce malarial chills in those 
predisposed to them. He also asserts that strychnine acts more power- 
fully when given by the rectum than by the mouth. This is doubtful. 



OPIUM. 335 

Administration. — The extract of nux vomica (Extractum Nucis 
Vomica?, U. S. and B. P.) is given in the dose of \ to \ of a grain 
(0.01-0.016); the fluid extract [Extractum Nucis Vomicce Eluidum, 
U. S. ; Extractum Nucis Vomica? Liquidum, B. P.), in the dose of 1 
to 5 minims (0.05-0.3); the tincture (Tinctura JS/ucis Vomicce, U. S. 
and B. P.), in the dose of 5 to 30 minims (0.3-2.0). Stryclmince 
Sulphas, U. S., and Strychnine Hydrochloride (B. P.) are given 
hypodermically in the dose of ^ to ^V of a grain (0.002-0.003), and 
by the mouth in the same amounts. In cases of severe surgical shock 
as much as -^ grain (0.016) may be used hypodermically. The B. P. 
recognizes a solution (Liquor Strychnine Hydrochloridi)', dose, 2 to 
8 minims (0.1-0.5). 

OPIUM. 

Opium (U. S. and B. P.) is the juice or milky exudation appear- 
ing on the surface of the unripe capsules of white poppy or Papaver 
somniferum, a native plant of Asia, now grown in many other parts of 
the world. 

Good opium, according to the U. S. P., should contain at least 9 per 
cent, of crystalline morphine, but the powdered opium (Pulvis Opii. IT. 
S.) should contain not less than 13 or more than 15 per cent, of morphine. 

The chemical composition of this drug is very complex, no less than 
seventeen alkaloids having been obtained from it, the most important 
of which are morphine, codeine, narcotine, thebaine, narceine, papaver- 
ine, pseudomorphine, and laudanine. It also contains meconic acid 
and meconine. 

Physiological Action. — The action of opium upon man and the lower 
animals varies with the degree of intelligence or cerebral development. 
It quiets the brain and excites the spinal cord. 

Nervous System. — The dominant action of opium upon man is to 
produce nervous sedation in small doses and sleep when given in larger 
amounts. Sometimes, however, in persons who are accustomed to its 
use, it produces a state of restless insomnia or quiet, wakeful apathy. 
When given to frogs it often produces tetanic convulsions, owing to its 
primary stimulant effect on the spinal cord. In dogs it increases the 
reflexes and produces drowsiness, and in man sleep. If, however, the 
patient be a member of one of the lower races or a young child, 
the spinal irritation may be as manifest as the cerebral sedation. If 
large doses are given, sleep is produced in all animals, and both the 
brain and spinal cord are depressed. The sensory nerves are also 
markedly benumbed, and the motor nerves may finally be rendered 
inactive. 

Circulation. — Small therapeutic doses of opium have no effect 
upon the circulation, but large ones slow the pulse, increase its force, 
and slightly raise arterial pressure. 

The slowing of the pulse depends upon stimulation of the pneumo- 
gastric nerves peripherally and centrically ; the increase in pulse-force 
rests upon the stimulation of the heart-muscle and its ganglia : the rise 
of pressure is due chiefly to the increased heart-action. 

After poisonous doses the pulse becomes rapid and feeble, due to 



336 DRUGS. 

depression of the vasomotor centre and the heart, and the gradually 
increasing asphyxia. 

Respiration. — In very minute doses opium is a feeble stimulant, 
or at least not a depressant, to the function of respiration. In over- 
dose it is one of the most powerful paralyzants of the respiratory cen- 
tres in the medulla oblongata, causing death by this action. 

Temperature. — The bodily temperature is raised slightly by full 
doses and lowered by poisonous amounts of opium. 

Tissue-waste. — Opium acts as a preventive to tissue-waste, decreas- 
ing the elimination of urea and other results of nitrogenous break-down. 

Elimination. — The drug escapes from the body, if given in excess, 
as morphine, by way of the intestines and kidneys, but most of it is 
destroyed by oxidation in the liver and tissues. Experiments made 
by Alt and Tauber show that morphine is chiefly eliminated by the 
stomach, and that if this viscus is frequently washed out during a case 
of poisoning, recovery is much aided, as by this means reabsorption is 
prevented. 

Pupil. — Opium contracts the pupils by a centric stimulation of 

Fig. 51. 




A, Opium produces sleep by depressing the intellectual centres of the brain, and B, relieves 
pain by depressing the perceptive centres in the brain. 

the oculo-motor nerves, and perhaps by depression of the sympathetic 
fibres. 

Stomach, Intestines, and Secretion. — Opium depresses the 
motor activity of the stomach and intestines and produces constipa- 
tion. It does this by stimulating the splanchnic inhibitory fibres of 
the intestine and thereby preventing peristalsis. In very large doses 
it increases peristalsis by paralyzing these fibres. 

Opium checks every secretion in the body except that of the 
skin. 

Acute Poisoning. — When opium is taken by man in overdose it 
causes drowsiness, deep sleep, full breathing, a slow, full pulse, a 
warm, dry skin, contracted pupils, and pleasant — or, more commonly, 
in the Anglo-Saxon race, disagreeable — dreams or no dreams at all. 

Preceding this period there may be a brief one during which the 
person feels self-satisfied and contented. The duration of this agree- 
able sensation only lasts a short time, and if the dose is large does 
qoI occur or at once passes off. It has been called the first stage, 
while the more marked symptoms just described have been grouped 
into a so-called second stage. 



OPIUM. 337 

During the sleep of the second stage the patient may be roused by 
shouting in his ear or by violent shaking, but sinks back into slumber 
at once on being left alone. 

Many of the symptoms resemble those of congestion of the brain. 
The face is suffused and reddened, and may be finally distinctly cyan- 
otic. The breathing may be puffing and stertorous. When the 
patient is awakened he breathes more rapidly, and for this reason the 
duskiness of the face disappears and the normal hue returns. Death 
never occurs in the second stage of opium poisoning from the poison 
alone, but if a complicating disease is present death may take place 
at this time. 

The third or fatal stage emerges from the second by a process so 
gradual that no abrupt line of separation can be noted. The face 
becomes at first more cyanotic, then pale and livid ; the respirations, 
which have been eight to ten to the minute, are now only four or five, 
and finally such prolonged pauses occur that all hope of another res- 
piration is lost by the attendant. While the slow breathing is at first 
deep, it rapidly becomes shallow, and muscular relaxation is present 
to the greatest degree. The skin, previously dry, is wet with the 
sweat of death, the patient is so deeply narcotized that nothing can 
arouse him, and he dies from respiratory failure, although the heart 
may cease almost simultaneously from the asphyxia. The pupils do not 
dilate in the third stage, except in the relaxation of death. 

Treatment of Acute Poisoning. — After employing the usual 
methods resorted to for the purpose of unloading the stomach, and 
after giving permanganate of potassium or tannic acid, preferably the 
former, as the chemical antidote, the patient should receive one or 
two cups of strong black coffee, hot and concentrated. The heat in 
the liquid is useful in maintaining bodily temperature, and the caf- 
feine stimulates the respiratory centre and keeps the man awake. 
Coffee should be used even before any symptoms come on, in order to 
put them off if possible. If strychnine is at hand and the respirations 
are becoming very slow, ^ to -^ of a grain (0.003-0.006) should be 
given hypodermically. Strychnine is much better than atropine as an 
antidote to opium, and should be given hypodermically in full dose, 
repeated frequently enough to keep the nervous system of the patient 
active and respiration intact. The pupil is no guide as to the action of 
atropine in opium poisoning, as the action of these two drugs (opium 
and atropine) on the eye is not directly antagonistic. 

Alcoholic stimulants may be called for, and ammonia as a cardiac 
and respiratory stimulant may be resorted to. 

In the third stage heat should be applied to the trunk and extrem- 
ities. 

Much emphasis has been placed on keeping the patient awake, 
and it has been thought that the cause of death was the deep sleep. 
This is not so. The man must be kept awake in order that he will 
supplement the efforts of his depressed respiratory centres by volun- 
tary breathing. If he sleeps, he forgets to breathe, and sleep means 
death for this reason, and not because sleep in itself produces death. 

Besides the use of the hot strong coffee, the patient may be kept 
22 



338 DRUGS. 

awake by lashing him with switches or by keeping him walking up 
and clown between two attendants. Both of these measures are rep- 
rehensible if anything better can be done — the first method because it 
covers the patient with cuts and bruises, the second because it may 
aid in the production of death by exhaustion. If an ordinary med- 
ical faradic battery is at hand, the full force of the current may be 
allowed to come in contact with the skin from two small poles wet 
with salt water, or, better still, the dry or wire electric brush should 
be swept over the body while the negative pole is held in the hand of 
the patient or pressed against his skin. This causes the most exqui- 
site pain in the normal individual, but if the brush is kept moving 
will not cause any bruises or discoloration. (See Asphyxia.) Arti- 
ficial respiration may be resorted to. 

As already pointed out when discussing the elimination of opium, 
the dose is eliminated into the stomach from the blood-vessels and then 
reabsorbed. Frequent washing out of the stomach is therefore advis- 
able in treating cases of poisoning. 

Chronic Poisoning. — Morphine or opium when taken constantly 
generates a habit. The person — or morphine-habitue, as he is some- 
times called — depends for a comfortable existence on the drug, and 
day by day increases his dose until the most extraordinary amounts 
are taken by the stomach or by means of the hypodermic needle. If 
the drug is withheld, a train of symptoms typifying depression or 
exhaustion ensues. The pulse is scarcely to be felt, horrible mental 
depression and melancholia come on, the miserable man or woman 
wrings his or her hands, and begs, screams, howls, or yells for mor- 
phine, only to break down and cry on being refused the customary 
dose. Diarrhoea of a serous type and most violent in character, with 
cramps in the muscles, may assert itself, and must be controlled by 
astringents and an active line of treatment as far as possible free 
from opium. (See Diarrhoea.) 

A characteristic symptom of chronic opium-eating is the develop- 
ment of the most clever lying in previously truthful persons. In the 
same breath that the patient begs the physician to cure him, he will 
lie to obtain the drug in a surreptitious manner, and may even have 
the drug in his mouth at the moment he speaks. It will often be 
found hidden in the seams of the clothing in small packages, and the 
nurse must be absolutely reliable, above bribery, and forever on the 
watch lest the drug be obtained by smuggling. Any sudden improve- 
ment on the part of the patient should be placed to the credit of more 
morphine, not to professional skill. 

Treatment. — The best way to treat such cases is to "taper off'' 
the daily dose, and to decrease by a sixth or a fourth the total cus- 
i oin.i iv amount in each twenty-four hours. The sudden complete 
withdrawal of the drug is an unnecessarily severe measure, and its 
withdrawal in a slower manner than that named is simply prolonging 
the treatment beyond reasonable limits. Cocaine has been used to 
tide over the crisis after the withdrawal of morphine, but too fre- 
quently the patient passes from opium to the cocaine, and finally to 
the alcohol habit, all of which arc equally bad. If the circulation 



OPIUM. 339 

flags, digitalis and strychnine may be given and the remaining symp- 
toms treated as common sense indicates. 

Sometimes paregoric is taken in excess, and the writer has seen and 
treated a case in which over a pint of paregoric was taken every day. 

When a mother is an opium-eater, the new-born child often suffers 
from collapse on the second or third day after its birth, owing to the 
lack of its customary dose of opium. 

Therapeutics. — Opium is used for the relief of five great conditions, 
which will be spoken of seriatim, the minor uses of the drug being 
considered afterward. These are pain, insomnia, inflammation and 
irritation, over-secretion, and systemic strain. 

Pain. — Opium is the best remedy that we possess for the relief 
of all forms of pam, except in those instances when neuralgia exists, 
when antipyrin and its fellow-compounds exceed it in medicinal value 
because they have no marked after-effects. It is to be remembered, 
however, that no drug has yet been discovered which equals its pain- 
relieving power in this or any other painful affection. In one form of 
pain opium is not to be employed — namely, that arising from cerebral 
congestion and cerebritis, for it is distinctly contraindicated in these 
affections, as it makes them worse. In acute or traumatic meningitis, 
however, opium is of great service, either alone or combined with 
mercury in sthenic cases. In the treatment of cases of renal and 
hepatic colic associated with spasm, and in dysmenorrhea, bella- 
donna and opium given together will relieve the spasm and pain, and 
yet so counteract each other elsewhere in the body as to be devoid of 
marked effect upon other organs. Usually in these severely painful 
affections it is best to give morphine and atropine hypodermically. 
Persons suffering from severe pain will always bear larger amounts of 
opium than individuals without pain. 

For the relief of violent pain physicians of experience usually 
employ morphine hypodermically as the most rapid and effective 
means of giving relief. If this is not possible, the morphine should 
be given by the mouth in a little hot water with or without whiskey 
or brandy added to it ; or deodorized tincture of opium may be given 
in the same manner. If neither the hypodermic needle nor the 
draught can be resorted to, then the drug is best given in the form 
of the fluid extract, or tincture, by the rectum, being first mixed with 
some warm starch-water. If the pain is chiefly in the pelvic viscera, 
the rectal administration of the drug is always advisable by injection 
or by suppository. 

When the pain is due to violent sciatica or to muscular spasm it is 
best relieved by injecting the morphine directly into the subcutaneous 
tissues over the affected part. In other instances local pain due to 
superficial inflammation may be relieved by compresses wet with 
laudanum and lead-water. 

To patients who are prone to frequent attacks of pain opium must 
be given with the greatest caution, as the "opium-habit" is easily 
produced. 

Insomnia. — Opium, while capable of producing sleep in almost 
every case in which it is given, save in those persons who by reason 



340 DRUGS. 

of idiosyncrasy are made wakeful by it, is only to be used in those 
instances where the sleeplessness is due to pain. If constantly used 
for the relief of insomnia or pain, the opium habit is rapidly contracted, 
and for this reason the use of this drug should be alternated with 
chloral, cannabis indica, and other soporific drugs. 

In some cases chloral and morphine, when given in small doses in 
combination, will so act upon the brain as to produce sleep. 

Thus, in the following prescription, the dose of both active ingredi- 
ents is much smaller than would be needed if either one was used 
alone, yet the result sought by their use — namely, sleep — is readily 
produced : 

R. — Morphinae sulpk gr. ij (0.10). 

Chloralis 3j (4.0). 

Syrupi f|j (32.0). 

Aquae dest . . q. s. f§ij (64.0).— M. 

S. — Dessertspoonful (8.0) at nine p. m., and, if needed, again at ten or eleven 
o'clock. 

In the persistent insomnia of typhoid fever, croupous pneumonia, 
and all acute diseases in which nervous exhaustion is due to lack of 
sleep, a hypodermic injection of morphine will sometimes produce most 
excellent results, but the proper use of cold bathing is to be preferred 
for this purpose if it can be employed. (See Cold, Part III.) 

Inflammation and Irritation. — Opium seems to possess some 
influence over inflammation which we cannot explain, and both small 
and large doses are particularly valuable in inflammation of serous 
membranes, such as peritonitis, meningitis, and pericarditis. In 
peritonitis opium has been thought to be very useful, but grave 
doubts are now entertained as to its value. (See the article on Peri- 
tonitis in Part IV.) It allays the nervous excitement and cough 
following haemoptysis, and the intense unrest caused by itching skin 
diseases, as, for example, the irritation of small-pox. 

Sometimes intense irritation or inflammation produces so great an 
effect upon unstriped muscular fibres as to cause spasm or paralysis, as 
in retention of urine, cystitis, or the constipation following inflammation 
of the bowels due to the ingestion of irritating foods ; under these cir- 
cumstances the employment of opium is indicated, and is usually very 
successful. In irritative coughs morphine given in syrup of wild-cherry 
bark does good in the dose of ^ to T a F of a grain (0.005). 

In some cases of irritable cough, due to a tickling sensation in the 
larynx much relief can be had by inhaling the steam arising from a 
cup of boiling water in which has been placed a drachm or two of pare- 
goric. 

Whenever a cough is in excess — that is, greater than is necessary o 
free the lung from mucus — morphine may be given in small doses. If 
the lungs contain more rales after its use than before, its use must be 
stopped, as the increase in the number of rales indicates an increase in 
the accumulation of mucus. 

In the treatment of strangury due to cystitis, and in rectal inflam- 
mation, provided they are not acute, and after operation on the pelvic 
organs, suppositories of the strength of \ or } of a grain (0.016-0.03) 



PLATE III. 




Chart showing the effect of opium in a ease of diabetes mel- 
litus. On the day of admission the patient was placed on a full 
house diet. The quantity of urine and fluid ingested at once 
increased. He then was placed on a restricted diet which 
caused a fall in the urine and fluids ingested but no decrease in 
sugar. Opium was now given and the sugar fell at once (see 
green line). Later on the house diet was resumed but the 
opium held the sugar in check. Note how the fluids increased 
on the 28th of May and how they fell when the opium was 
renewed and increased. The chart shows how the restricted 
diet governed the urinary flow and how the opium was needed 
to control the mellituria. 



OPIUM. 341 

of the watery extract of opium are very useful. In excessive vomit- 
ing from any cause, except it be from a previous dose of opium, 
an enema of deodorized laudanum 30 minims (2.0) and starch-water 

4 ounces (120.0), with 40 grains (2.6) of bromide of sodium, will be 
found of value. (See Vomiting, Part IY.) 

In muscular rheumatism and similar states, and when a " cold " 
has been taken, opium in the form of Dover's powder in the dose of 

5 to 10 grains (0.31-0.65) will often produce a cure, particularly if 
employed in combination with hot drinks and a hot foot-bath. Cam- 
phor can often be added to the Dover's powder with advantage. (See 
Coryza, Part IV.) 

For sprains and bruises lead-water-and-laudanum is one of the best 
applications. (See Article on Lead.) If the skin is broken, the lau- 
danum may be used alone to relieve pain, and, by its alcohol, will act 
as an antiseptic. Opium is also a useful drug in the treatment of inter T 
nal and external burns to relieve the pain and irritation. 

Over-secretion. — In serous diarrhoea, diabetes insipidus, and mel- 
litus, and in the treatment of over-secretion on the part of all secre- 
ting surfaces except the skin, opium may be used. 

It is said to decrease the amount of urine before decreasing the 
amount of the sugar in diabetes. However this may be, the employ- 
ment of opium or morphine or codeine in diabetes is a very valuable 
form of treatment. The doses should be rapidly increased, as the 
effect is only obtained by ascending amounts, and diabetic patients 
seem peculiarly immune to the nervous influence of this drug and 
its alkaloids. Morphine is, therapeutically, the more powerful of the 
two alkaloids, but crude opium is more powerful for good in this 
affection than either. None of them, probably, cure the disease, but 
so modify it as to make life bearable and happy, for the sugar is 
decreased in many cases and the sense of excessive hunger, thirst, 
and nervous irritability is put aside. Itching of the skin is also re- 
lieved in this class of patients by its use. (See Plate, and also article 
on Diabetes, Part IV.) The sudden withdrawal of opium from a case 
of diabetes may precipitate diabetic coma. 

Opium should not be used to arrest an attack of mucous diarrhoea 
until after the mucus which is already present in the bowel has been 
swept out of the intestinal canal by a dose of castor oil or magnesium 
sulphate. Minute doses of -g 1 ^- to -^ of a grain (0.001) of morphine 
given hypodermically will sometimes check summer diarrhoea in chil- 
dren at once. (See article on Diarrhoea.) 

Morphine is used to relieve pain rather than opium, because it does 
not cause so much constipation, but opium is better to check diarrhoea. 
Paregoric is particularly useful in diarrhoea because it contains a 
volatile oil and camphor. 

Systemic Strain. — In prolonged strain upon the system, as in 
great physical or nervous effort, or more frequently in old age to 
smooth out the cares of the remaining years of life and decrease worry, 
opium is useful, but its use in young persons is most dangerous, as it is 
almost certain to produce the opium habit. In asthenic fevers opium 
is thought to be supportive, but its use is apt to cause so many other 



342 DRUGS. 

conditions, such as constipation, anorexia, or mental depression, that 
alcohol is much better for this purpose. In very advanced phthisis it 
is often justifiable to give enough opium to keep the patient free from 
pain and discomfort for the remaining hours of his life, but care must 
be taken that the dose does not interfere with his breathing and so 
hasten death. 

In heart disease, particularly of the mitral valves, the patient can 
often breathe easily only when awake, starting up when he falls 
asleep and gasping for breath. It is stated by some writers that 
morphine will relieve this state and permit sleep, but that it will 
not be of service in aortic disease. While this may be partly true, 
the drug will often give great relief in all forms of cardiac dyspnoea, 
and ought always to be tried with caution, although it is contraindi- 
cated if the heart has undergone fatty degeneration. Care should be 
taken that the first dose is small, as in some instances it increases the 
discomfort. The relief obtained is supposed to be due to cardiac stim- 
ulation by the drug, and, while this is no doubt correct, the other car- 
diac stimulants, such as digitalis, will often fail when morphine suc- 
ceeds. The presence of cyanosis and lividity is said to be no con- 
traindication to the hypodermic use of morphine under these circum- 
stances, provided the dose is not unreasonably large, and provided 
these signs are purely circulatory in origin. If they depend upon 
pulmonary oedema or diffuse bronchitis, it is unsafe. The drug should 
be driven hvpodermicallv for this purpose in the dose of about J strain 
(0.016). 

Opium and morphine, particularly the latter, have been freely 
given to produce quiet in patients with uremic convulsions. The 
practice is a dangerous one and should not be resorted to as a rule, as 
the impaired state of the kidneys prevents the proper elimination of 
the drug. 

Administration. — Recent studies upon the action of opium and its 
alkaloids show that it acts in an inhibitory manner upon gastric diges- 
tion and absorption, decreasing the amount of hydrochloric acid in 
the gastric juice. For this reason, unless there is an excess of acid 
present in the stomach, it is well not to give opium or morphine at 
meal-times, but some time after. 

Opium itself is used in the form of the powder [Pulvis Opii, U. S.) 
in the dose of from J to 1 grain (0.016-0.05). The solid preparations 
are the deodorized opium (Opium Deodoratum, U. S.), which is de- 
prived of its narcotine, dose \ to 1 grain (0.03-0.05); the pills of 
opium (Pilulce Opii, U. $.), each containing 1 grain (0.05): and the 
watery extract (Extractum Opii, U. S. and B. P.), dose | to \ a grain 
(0.016-0.03). Of the liquid preparations wo have paregoric [Tinctura 
Opii Camphorata, U. S. ; Tinctura Camphorce Compo&ita) B. P.), 
dose 1 drachm to 1 tablespoonful (4.0-1 5.5) ; laudanum [Tinctura 
Opii, U. S. and B. P.), dose 10 to 30 minims (0.G5-2.0) ; the deodo- 
rized tincture ( Tinctura Opii Deodorati, U. S.), dose 10 to 30 minims 
(0.6-2.0); the Vitium Opii, U. S.. or. a- it is sometimes called. 

Sydenham's Laudanum — dose 10 to 30 minims (0.65-2.0); and 

Acetum Opii, U. >S., or Black Drop, dose 10 to 30 minims (0.65-2.0). 



OPIUM. 343 

As all the liquid preparations of opium in the IT. S. P. are of 10 
per cent, strength, except paregoric, which is about 2 grains to the 
ounce, the dose of all of them except paregoric is identical. This is 
a fact to be remembered by students. 

Under the name of Dover's Powder {Pulvis Ipecacuanhce et Opii, 
IT. S. ; Pulvis Ipecacuanhce Compositus, B. P.), a powder containing 
1 part of powdered opium, 1 part of powdered ipecac, and 8 parts of 
sugar of milk, is largely used. The dose is 5 to 10 grains (0.3-0.65). 
It is more efficacious if separated into fifths and taken in divided doses. 
The tincture of ipecac and opium (Tinctura Ipecacuanha? et Opii, 
IT. S.) is given in the dose of 5 to 15 minims (0.3-1.0). 

The preparations of opium official in the B. P., other than those 
already named, are Pxtr actum Opii Liquidum, dose 4 to 20 minims 
(0.3-1.3); Pulvis Opii Compositus, composed of opium, pepper, ginger, 
caraway-fruit, and tragacanth, dose 2 to 5 grains (0.1-0.35) ; Tinctura 
Opii Ammoniata, dose -| to 1 drachm (2.0-4.0). Pilula Saponis Com- 
p>osita, B. P., is purely a preparation of opium. It is sometimes neces- 
sary to give this drug to patients without their knowledge, and it may 
be prescribed in this way, the patient not learning from the prescription 
the' nature of the medicine. The dose is 2 to 4 grains (0.1-0.2). 

The B. P. also recognizes a liniment (Linimentum Opii) and a 
plaster (Emplastrum Opii) for local application. 

Untoward Effects. — When opium is given to some persons it pro- 
duces for some hours marked wakefulness followed by sleep, and in 
many patients produces after its primary influence great nausea, and 
sometimes vomiting. The mental depression may be simply over- 
whelming, and the very fact of having to drag out existence is a curse. 
By far the most effective mode of preventing these very distressing 
effects of opium or its derivatives is to administer with this drug about 
2-^q- grain of nitroglycerin. One of the chief causes, however, of the 
nausea produced by the use of opium or morphine is the change in the 
body of morphine into oxy-dimorphine, which is eliminated into the 
stomach and there reabsorbed, and then induces these secondary effects. 
It is also a fact that these symptoms can be largely done away with by 
the use of 20 grains (1.3) of bromide of potassium, which must be taken 
at the same time as the opiate, and by employing the preparations of 
opium largely devoid of narcotine, such as the deodorized tincture or 
deodorized opium itself. Whenever it is possible these preparations 
should be used to the exclusion of the others. Haig is responsible for 
the assertion that, as opium frees the blood of uric acid by causing its 
retention in the tissues of the body, the pleasant effects are so produced, 
and that, the retention being cumulative, no sooner does the effect of 
the opiate pass off than the uric acid is set free in the blood, and as a 
result depression ensues. He states that if salicylates are given with 
the opium the retention does not occur, and the unpleasant sequelae are 
much modified or prevented. After the untoward symptoms come on 
coffee and stimulants may be used with advantage to overcome them. 
In some persons the use of opium is followed by itching of the skin or 
by the development of an erythematous rash which may go on to 
desquamation. 



S44 DRUGS. 

Children bear opium badly, and some children are very much more 
susceptible than others to its influence. 

One-eighth grain of morphine has caused death in an adult when 
given hypoderrnically, probably because it entered a vein. Sometimes 
the drug causes collapse, or in other cases an eruption upon the skin 
of the body. 

The use of repeated doses of morphine for several days often sets up 
obstinate vomiting, due probably to the change of the drug into oxy- 
dimorphine or apomorphine. 

Codeine. 
(See p. 194.) 

Morphine. 

Morphina, U. S. and B. P., is the chief alkaloid of opium, but 
owing to its insolubility is rarely used, being generally given in the 
form of the sulphate. 

Sulphate of Morphine (Morphince Sulphas, U . S.) is given in 
the dose of ^ to \ grain (0.008-0.03), either by the mouth or hypo- 
dermically. Besides the sulphate of morphine we have the acetate 
(Morphince Acetas, U. S. and B. P.), the muriate (Morphince Hy- 
drochloras, U. S., and Hydrochloridum, B. P.), and the tartrate 
(Morphince Tartras, B. P.), all given in the dose of J to J grain 
(0.008-0.03). In the U. S. Pharmacopoeia of 1870 a solution of 
morphine was official, called Liquor Morphince Sulphatis (B. P.), dose 
1 to 2 drachms (4.0-8.0) ; but it is no longer official and should not be 
called for. Magendie's solution of morphine is sixteen times as strong 
as this liquor just named (16 grains to the ounce), and is also not 
official. The words "Liquor Morphinae Sulphatis" will often cause 
Magendie's solution to be dispensed in New York State, and care 
should be taken that poisoning does not result. Pulvis Morphince 
Compositus, U. S., or Tully's Powder, is given in the dose of 10 
grains (0.65). It contains sulphate of morphine, camphor, licorice, 
and precipitated calcium carbonate. It is used to break up forming 
colds and as a nervous sedative. Troches of morphine and ipecac 
(Trochisci Morphince et Ipecacuanha?, U. S.) are given one or two at 
a time for irritation of the pharynx. 

The following additional preparations of morphine are official in the 
B. P. : Liquor Morphince Hydrochloridi, Liquor Morphince Tartratis, 
dose 10 to 40 minims (0.65-2.65) ; Tinctura Chloroformi et Morphince 
Composita, dose 5 to 10 minims (0.35-0.65); Suppositoria Morphince, 
each suppository containing \ grain (0.017) of morphine; Trochiscus 
Morphince and Trochiscus Morphince et Ipecacuanha, each lozenge 
containing :} \ r of a grain (0.002) of morphine, dose 1 to 4. Liquor 
Morphince Acetatis is given in 20- to 40-minim (2.65) doses. Injectio 
Morphince Hypodermica, B. P., contains 1 grain (0.05) of the tartrate 
of* morphine in each 22 minims (1.4) of water. Its dose is 1 to 5 
minims (0.05-0.2). 

Incompatibles. — Morphine is incompatible with potassium perman- 



ORTHOFOBM-OX-GALL. 345 

ganate and with tannic or gallic acid or astringent solutions containing 
them, with alkalies, such as potassium, sodium, and ammonium, but 
with the chloride of ammonium it is not incompatible. With tincture 
of chloride of iron it forms a deep-red color (meconic acid). 

ORTHOFORM. 

Orthoform is a colorless, bulky, odorless, and tasteless powder which 
is slightly soluble in water. It is used as a local anaesthetic and anti- 
septic dressing for small wounds and burns, and is said to be non-toxic, 
but this is an error. It may be applied in powder or ointment. The 
latter is usually of the strength of 2 drachms to the ounce of lanolin 
(8.0-30.0). Brocq asserts that it is capable even in weak ointments of 
causing great irritation of the skin, and Epstein has found it capable of 
producing poisoning if given by the mouth. 

OVARIAN EXTRACT. 

The ovarian gland, in the form of the dried gland substance or in 
that of an extract made from it, has been used for the relief of the 
nervous and nutritional disturbances of the menopause, whether they 
be the result of age or of operative removal of these bodies. It is said 
to be most efficacious in those instances in which the ovaries have been 
removed from young women. As the use of the ovarian extract in 
medicinal doses seems to be harmless, it may be given for a long time 
without danger. The beginning dose should be 2 to 4 grains (0.1-0.2) 
a day, and this be gradually increased until some effect is produced or 
it proves itself useless. The best method of giving it is in compressed 
tablets or in capsules. Professional opinion as to its value is very 
contradictory. 

OX-GALL. 

Inspissated Ox-gall (Fel Bovis, U. S.) is, as its name implies, dried 
ox-bile, derived from the gall-bladder of the common ox (Bos Taurus). 
It is used in medicine for the purpose of relieving certain forms of 
indigestion which depend upon deficient secretion of bile or which occur 
in persons who digest fats with difficulty. In full doses it is apt to 
cause some looseness of the bowels, and it may be given with the object 
of producing this condition. When it is used the fact should be 
remembered that bile prevents the gastric juice from acting upon pro- 
teid or albuminous substances, shrivelling them up, and in addition 
so alters the gastric liquids as to decrease their digestive power. We 
know, therefore, that this drug must be administered some hours after 
meals, as a rule, or, in other words, when gastric digestion is ended 
and intestinal activity is beginning. The dose of inspissated ox-gall, 
which is dried by evaporation from 100 to 15 parts, is 5 to 15 grains 
(0.35-1.0). Purified Ox-gall {Fel Bovis Purificatum, U. 8.; Fel 
Bovinum Purificatum, B. P.) is given in the same dose as the inspis- 
sated bile. It is made by evaporating 3 parts of pure ox-gall to 1 
part, and then adding to this part an equal amount of alcohol, which 



346 DRUGS. 

constituents are mixed thoroughly, and after standing twenty-four 
hours the clear liquid is decanted and the residue is evaporated to a 
consistency capable of forming a pill. 

OXIDE OP ZINC. 

Commercial Oxide of Zinc (Zinci Oxidum Venule) is not used in 
medicine, but in the purified form is largely employed in the shape 
of Zinci Oxidum, U. S. and B. P., which is insoluble in water. In 
the form of the oxide-of-zinc ointment ( Unguentum Zinci Oxidi, TJ. S. 
and B. P.) this drug affords one of the most generally used applica- 
tions in the treatment of skin diseases, burns, and sores. 

In all states where the surface of the skin is dry it is contraindi- 
cated, but where the eruption is moist it is useful. In the treatment 
of the chloasma of pregnancy the following prescription is of service: 

R. — Zinci oxidi gr. iij (0.2). 

Hydrarg. ammoniat gr. j (0.06). 

Olei theobromse 3ij ss (10.0). 

Olei ricini ^ijss (10.0). 

Essent. rosse gtt. x (0.65). — M. 

S. — Apply to the face night and morning. 

In eczema with many vesicles use — 

R. — Pulv. camphorse £ss (2.0). 

Pulv. zinc, oxidi giij (12.0). 

Glycerini gtt. xl (2.65). 

Adipisbenzoinati 2j (30.0).— M. 

S. — Apply to the part without other treatment or precede it by powdered bis- 
muth. 

Under the name of Unna's Dressing (composed of gelatin 4 parts, 
water 10 parts, glycerin 10 parts, and zinc oxide 4 parts) is a useful ap- 
plication for ulcers and eczematous patches on the legs or arms. It is par- 
ticularly useful for leg ulcers. The gelatin and cold water are put in a 
basin over a fire and a solution made ; then the glycerin is added, and 
then the oxide of zinc is slowly added, with constant stirring. After 
the mixture is complete it is poured into a can and allowed to cool, 
when it is ready for use. This application decreases swelling and is 
soothing and supporting. It is applied as follows : The part affected is 
well washed with water and soap, and then with alcohol. The paint 
having been warmed and melted, a large three-inch paint-brush is used 
to apply a coating to the limb all around the ulcer, and over this a 
single layer of gauze is applied. The gauze bandage should be two 
inches wide. The bandage must be laid on evenly and the ulcer cov- 
ered by a pad of absorbent cotton. After one layer is applied it is cut 
and another coat of paint applied over it. Then another layer of gauze 
and another of paint are used, until several layers are in place. It is 
best to begin at the toes and work up toward the knee. All parts 
should be equally well covered. Finally the entire dressing is covered 
by a cotton roller bandage, which is removed in twenty-four hours, 
Leaving what looks like a white rubber dressing on the limb. If the 
li(|iiii| from the ulcer oozes through the dressing profusely, a window is 
to he cut over the ulcer, and it can be locally treated by astringents or 



OXYGEN. 347 

other measures. The patient should keep the limb elevated for a day 
or two, but can then walk with far more comfort than if a rubber sup- 
porting bandage is used. 

In powdered form zinc oxide is useful in the treatment of intertrigo 
and for conjunctivitis. Mixed with bismuth subnitrate and pepsin, it 
is largely used by some practitioners in the treatment of the summer 
diarrhoea of infants or adults. 

In the night-sweats of debility or of phthisis oxide of zinc in the 
following formula has been highly recommended, but the prescription 
probably depends largely for its action on the second ingredient : 

R. — Zinci oxidi gr. xxx (2.0). 

Extract, belladonna; gr. iij (0.18.)— M. 

Ft. in pil. No. x. 
S. — One at night before going to bed. 

Bartholow recommends the oxide of zinc for cases of asthma and 
whooping cough, given to an adult in the manner just indicated. 

OXYGEN. 

The gas Oxygen is now widely used in medical and surgical practice 
in three ways, as follows : By the inhalation of the gas itself from a 
cylinder in which it is compressed until 40 gallons occupy a very small 
space ; by drinking oxygen-water, which is distilled water saturated 
with the gas ; and finally, by the use of the dioxide or peroxide of 
hydrogen, which is applied locally to diseased surfaces. (See Hydrogen 
Peroxide.) 

Inhalations of oxygen are useful in the second and third stages 
of pneumonia where the patient seems about to die from deficient aera- 
tion of the blood, with resulting heart-distention. They are also of 
value in advanced bronchitis, particularly that of old persons, and for 
the resuscitation of persons asphyxiated by coal-gas (Hare and Martin). 
In phthisis and other exhausting diseases oxygen will allay dyspnoea 
and oppression. Oxygen inhalations are also of service in the treat- 
ment of anosmia in all its forms and give relief even in pernicious 
anosmia and in leukaemia. Often a mixture of oxygen gas 60 parts 
and nitrous oxide gas 40 parts is used as a stimulant inhalation and 
nervous sedative. 

The clinical results which have so far been obtained from the admin- 
istration of ether and chloroform vapor when combined with oxygen 
gas seem to prove beyond all doubt that the oxygen decreases the dan- 
ger of the anaesthetic and to a large extent obviates the difficulties 
which surround the administration of these drugs, and most of the 
untoward effects which we are accustomed to meet with as a conse- 
quence of their use. Thus, when oxygen is given with ether, vomit- 
ing is less frequently met with, excessive pallor is rarely seen, and 
post-operative depression seems to be largely avoided. 

As a general rule, however, it has been the custom of physicicans 
and surgeons who have employed oxygen gas in combination with ether 
or chloroform, to place the anaesthetic in a wash-bottle and then to 
allow the oxygen gas to pass through it in such a way that the patient 



348 DRUGS. 

received in the inhaler a mixture of anaesthetic vapor and oxygen, the 
mixture being made by the passage of the oxygen gas through the 
liquid anaesthetic in the bottle. An evident disadvantage of this 
arrangement is that the quantity of anaesthetic which is volatilized 
can only be in direct proportion to the volume of oxygen gas which is 
forced through the wash-bottle, and therefore with every increase in the 
quantity of vapor which the patient receives he must also receive an 
increased quantity of oxygen. It has been claimed, too, by those who 
have employed the ether and oxygen combination most frequently, that 
in a large proportion of cases a greater length of time is required 
for the anaesthetizing of the patient, and that in some cases it seems 
almost impossible to get the patient under the direct influence of the 
drug. This difficulty lies in the fact that as soon as a large quantity of 
oxygen gas is used to convey a large quantity of anaesthetic vapor to 
the lungs, the patient rapidly passes into a condition which is called by 
physiologists apnoea. The respiratory centre is no longer irritated by 
the normal proportions of carbonic acid in the blood, and therefore 
sends out feeble respiratory impulses ; and as the patient does not 
breathe as rapidly or as deeply as before, the result is that very small 
quantities of the anaesthetic are taken into the body. 

The apparatus which the writer has employed with success, and 
which he suggests as a substitute for the one heretofore employed, con- 
sists of a somewhat funnel-shaped piece of leather having a greater 
diameter in one direction than in another, into which is fitted as an 
inner lining a piece of soft felt or spongio-piline almost a quarter of 
an inch thick. In the under surface of the leather cone is inserted a 
small metal tube, and at the opening of this tube a small hole is cut in 
the spongio-piline. The ether is then poured upon the spongio-piline in 
the cone, in the apex of which is placed some absorbent cotton. The 
oxygen enters the cone by means of a rubber tube attached to the metal 
entrance which has been mentioned. By this arrangement several obj ects 
are accomplished. In the first place the supply of oxygen can be delivered 
to the patient in varying quantities without altering the amount of 
anaesthetic which is being given. In the second place, any quantity of 
anaesthetic can be employed without necessarily increasing the oxygen. 
Thirdly, the leather cone prevents the rapid evaporation of ether from 
the outer side of the spongio-piline. And fourth, the spongio-piline, being 
much more porous than an ordinary towel, will retain a large quantity of 
ether in liquid form when this drug is poured upon it. Finally, if desired, 
the same apparatus can be used for the administration of chloroform by 
removing the metal cap on the smaller end of the cone, as in this way 
the patient will receive not only the anaesthetic vapor and the oxygen, but 
also fresh air through the end of the cone, in such quantities as the phy- 
sician deems wise. In these cases it is best to use the attachment known 
as the Krohne and Sesemann "respiration-indicator," which consists 
of a small feather on a pivot which moves to and fro with the motions 
of respiration, thereby providing the physician with a gauge as to the 
rapidity and force of the respiratory movements. The soft felt is very 
cheap, and a fresh piece can be used for each patient. 

In conclusion, the writer cannot condemn too strongly the method 



PANCBEATIN AND PANCREATIC EXTRACTS. 349 

of employing chloroform vapor and oxygen by passing the oxygen 
directly through the chloroform without the free administration of air 
in addition, for, after all, air is what we are intended to breathe, and 
not oxygen gas alone, although it may be advantageous at times to add 
an increased quantity of oxygen to the air. 

Still more severe condemnation should be directed toward the attach- 
ment which is placed on some of the Junker inhalers, and which con- 
sists of a small rubber bag which, instead of acting as a reservoir of 
fresh anaesthetic vapor and oxygen, is inflated and collapsed by the 
expiration and the inspiration of the patient, who does not receive even 
fresh oxygen and anaesthetic vapor, much less fresh air, but, on the 
contrary, inhales again and again air, oxygen, and vapor which are 
loaded with the impurities of frequent expiratory efforts. 

(For the directions for using oxygen with nitrous oxide as an anaes- 
thetic see the article on Nitrous Oxide.) 



PANCREATIN AND PANCREATIC EXTRACTS. 

Under these names a number of firms now sell an extract from the 
pancreatic gland or juice, and the U. S. P. recognizes such a product 
under the name of Pancreatinum. It contains, or should contain, the 
four pancreatic ferments — trypsin, which digests proteids (meat, eggs, 
etc.) ; steapsin, which splits up and emulsifies the fats ; amylopsin, 
which has diastatic power (that is, converts starch into sugar), and 
finally a milk-curdling ferment. 

A preparation equally useful with the commercial pancreatin may 
be made by the physician in the following manner : 

Take the pancreas of a pig which has been killed about six hours 
after a full meal, the organ being therefore active, and, after chopping 
it up fine, add to it four times its weight of dilute alcohol and allow 
it to stand for twelve hours. Decant or filter off the alcohol, and 
give the filtrate in the dose of 1 to 2 drachms (4.0-8.0). Or, better 
still, as follows : Wash and chop up fine a fresh pancreas, and allow 
the gland to soak in alcohol (absolute) twenty-four to forty-eight hours. 
After this squeeze out the alcohol and add to the gland ten times its 
weight of glycerin. This must stand forty-eight hours and then be 
filtered, and be used in doses of 30 minims (2.0) to each glass of milk. 
(For the use of pancreatin in artificial digestion see the article on Pep- 
tonized Foods in Part III.) 

Pancreatin, as prepared for the market, is a dry powder, given in 
the dose of 2 to 20 grains (0.1-1.3) after meals or during them. 

Pancreatin should usually be prescribed with bicarbonate of sodium 
to aid it in its digestive action. It is indicated in all cases of lienteric 
diarrhoea and in many cases of deficient digestion. Pancreatin, or the 
powdered pancreas, may also be freely used in those cases of diabetes 
mellitus in which the disease depends upon a lesion of the pancreatic 
gland, as carcinoma or atrophy from other cause. 

Some doubt has been cast upon the usefulness of the employment 
of pancreatin in foods unless this ferment was allowed to act upon the 



350 DRUGS. 

aliment before it was swallowed by the pafient, on the ground that 
pancreatin is destroyed and rendered inert in the presence of the acid 
which it meets in the stomach. This objection is not a valid one, 
because food remains in the stomach for from fifteen minutes to half 
an hour before enough gastric juice is secreted to interfere with the 
pancreatic action. It is during this preliminary period that the work 
of the pancreatin is accomplished. 

Pancreatized or peptonized foods should not be employed unless 
really needed, nor continued for any length of time, as digestion is 
finally impaired by torpor of the glands arising from disuse. 

The B. P. recognizes a solution {Liquor Pancreatis) ; dose 1 to 2 
drachms (4.0-8.0). 

The dose of pancreatin is from 2 to 20 grains (0.1-1.3). 

PAPAIN, PAPAYOTIN, AND PAPOID. 

Papain, Papayotin, and Papoid are names given to a digestive fer- 
ment derived from the juice of Carica Papaya. This ferment pos- 
sesses the power of changing proteids into peptones in the presence 
of an acid or an alkali, or even in a neutral mixture, thereby differ- 
ing from pepsin and pancreatin. This power would be of very great 
value, since the drug would then be useful in all forms of dyspepsia, 
were it not that careful experimentation renders it doubtful as to 
whether papain, papayotin, or papoid can really supplant either of 
the animal ferments named above. The dose of all these products is 
from 1 to 8 grains (0.05-0.6) given in solution, or better in pill. The 
plant itself, taken internally, has the reputation of being capable of 



causing abortion. 



PARALDEHYDE. 



Paraldeliydum, U. S. and B. P., is a form of aldehyde used as a 
soporific and nervous sedative, and is a clear, colorless liquid with an 
ethereal odor and a burning, followed by a cool, taste. It should be 
kept in dark, well-stoppered bottles in a cool place. Paraldehyde is 
readily soluble in alcohol, moderately so in water, less so in hot 
water. It possesses the great disadvantages of being necessarily 
given in large dose and having a disagreeable taste and odor. It is 
also very apt to disorder the stomach. Paraldehyde kills when taken 
in overdose by respiratory failure, but is not so depressant to the 
heart as is chloral. The drug soon loses its power as a soporific. The 
dose is 20 minims to 1 drachm (1.3-4.0) in capsules, or, better still, 
it may be used, after the formula of Yvon, as follows: 

R.— Paraldehyde gijss (10.0). 

A Lcoholis (90 percent.) f^jss (45.0). 

Tincturse vanlllse f.^ss (2.0). 

Aqua destOlat f|j (30.0). 

Syrupi simplicis q. s. ad f^iv (120.0). — M. 

S. — A dessertspoonful (8.0) every half-hour until sleep is obtained. 



PAREIR A— PEPPERMINT. 351 



PAEEIRA. 



Pareira, TJ. S. (Pareirce Radix, B. P.), is the root of Chondoden- 
dron tomentosum, a plant of Peru and Brazil, and is used as a diu- 
retic of an alterative or stimulant character and for the relief of 
chronic inflammations of the genito-urinary tract in general, such as 
pyelitis, cystitis of a subacute type, and similar pathological states. 
The dose of the unofficial infusion is a wineglassful (31.0), and the 
fluid extract (Extractum Pareirce Fluidum, TJ. S.) is given in the 
dose of a teaspoonful (4.0) three times a day. The B. P. prepara- 
tion of this drug is Extractum Pareirce Liquidum, dose 1 to 2 drachms 
(4.0-8.0). 



PEPO. 

Pepo (Cucurbita Pepo), TJ. S., Pumpkin-seed, the seed of the ordi- 
nary domestic pumpkin, is a useful and efficient vermifuge against the 
tape-worm. The seeds are not only efficient, but harmless to the host 
of the worm. The outer coverings of the seeds should be removed, 
and the remaining part rubbed up into an emulsion with water or into 
an electuary with sugar, the dose of the seed being 2 ounces (62.0). 
This mass should be taken on an empty stomach, and followed in from 
one to two hours by an active purge. 



PEPPER. 

Piper, TJ. S., or Black Pepper (Piper Nigrum, B. P.), is the 
unripe fruit of Piper nigrum, a vine of India, Java, Borneo, and 
Siam. It contains a neutral principle, piperin, which is official. 

Therapeutics. — Black pepper may be used externally as a counter- 
irritant or internally as a carminative and stimulant to the alimentary 
canal. 

It may also be used in all cases of atony of the mucous membranes 
of the genito-urinary system, but is contraindicated whenever acute 
inflammation is present, as in acute gonorrhoea. It may be used in 
the treatment of great intestinal flatulence with marked relief. 

Piperin (Piperinum, TJ. S.) has been used as an antiperiodic with 
varying success, and is given in the dose of 1 to 5 grains (0.05-0.25). 
The oleoresin of pepper (Oleoresina Piperis, TJ. S.) is given in the 
dose of \ to 2 minims (0.016-0.1) in laxative pills, to prevent griping. 
A confection (Confectio Piperis) is official in the B. P., given in the 
dose of 1 to 2 drachms (4.0-8.0). 

PEPPERMINT. 

Mentha Piperita, TJ. S., is official in the form of the leaves and 
tops of Mentha piperita. It has an aromatic odor and taste and con- 
tains an oil. Locally applied, the oil acts as an irritant and local anaes- 
thetic. From this oil is obtained menthol, a camphoraceous substance 



352 DRUGS. 

of a hot, burning taste, possessing marked power as a local anaesthetic. 
(See Menthol, below.) 

Therapeutics. — Peppermint is used very largely as a domestic rem- 
edy for flatulence and infantile colic. Sometimes the oil is added to 
purgative pills to prevent griping, and it may be employed to cover 
the taste of many medicines which are disagreeable to take. In this 
respect it is used as are all the volatile oils. In the colic of children 
of six months to a year of age, when it is unusually severe and asso- 
ciated with nervous symptoms, the following will be found of value : 

R.— Chloralis . . .. gr. xvj (1.0). 

Potassii bromidi gr. xxxij (2.0). 

Aq. menth. piperit f^ij (60.0). — M. 

S. — Teaspoonful (4.0) in a little warm water every four hours. 

When used in the treatment of neuralgia, oil of peppermint should 
be placed on a piece of linen or muslin rag and applied over the 
affected spot. Care must be taken that it does not blister the skin. 
If, after its removal, the burning is too severe to be borne, a little 
cosmoline or olive oil should be applied. Oil of peppermint is 
sometimes placed on cotton and inserted into dental cavities for 
toothache. 

It is to be remembered that the more menthol is present in the oil 
the more active will it be as an anaesthetic, and that the Chinese oil 
contains more menthol than the American oil. 

Administration. — Peppermint is used in the form of the oil [Oleum 
Mentha? Piperita?, TJ. S. and B. P.), dose 1 to 4 minims (0.05-0.25); 
the spirit (Spiritus Mentha? Piperita?, TJ. S. and B. P.), dose 10 to 
30 minims (0.65-2.0); the water [Aqua Mentha? Piperita?, TJ. S. and 
B. P.), dose 1 to 2 drachms (4.0-8.0); and, finally, as the Troches 
(Trochisci 3Ientha? Piperita?, TJ. S.), to be held in the mouth in indef- 
inite number. 

Menthol. 

Menthol, TJ. S. and B. P., or Mint Stearopten, or, as it is called, 
Mint Camphor, is derived chiefly from the essential oil of pepper- 
mint. It occurs in colorless prismatic crystals with a strong odor of 
peppermint. Upon it rests much, if not all, of the therapeutic activity 
of peppermint. Menthol is slightly soluble in water, very soluble in 
alcohol, ether, and in oils. 

Menthol has been used in the vomiting of pregnancy with great 
advantage in hourly doses of a teaspoonful of the following : 

R.— Menthol gr. xv (1.0). 

Spt. frumenti f^vj (22.0). 

Syrupi f £j (30.0). 

Menthol has also been used as a carminative and in gastralgia in 
the dose of from 1 to 2 grains (0.05-0.1) three times a day in pill or 
in alcoholic solution. It is contraindicated in acute inflammation of 
the gastric mucous membrane. 

Ajb menthol exercises a local amesthetic effect on the skin as well 



PEPPERMINT. 



353 



as on mucous membranes, it is used externally over the course of 
neuralgic nerves and for migraine by means of menthol pencils. 

Menthol when applied to the mucous membranes of the throat or 
nose causes a contraction of the local 
blood-vessels, which is not followed 
by the excessive dilatation produced 
by cocaine. In acute coryza its local 
application to the mucous membrane 
by a spray or dropper is often a 
source of great relief in a solution 
of about 1 grain (0.05) to the ounce 
(30.0) of water, or 3 grains (0.25) 
of menthol in -^ an ounce (15.0) of 
albolene. (See Coryza, Part IV.) 

Another very useful method of 
applying menthol is by means of a 
simple inhaler consisting of a small 
glass tube of about one-quarter of 
an inch in diameter and two and a 
half inches in length. Both ends 
are closed by a piece of gauze and 
two perforated corks, the menthol 
being placed in between. The air 
is now drawn through this tube, and, 
being heavily loaded with the fumes, 
clears the nares and relieves the 
stuffiness. It is not to be only 
smelled, but inhaled. Care should 

be taken that the crystals are not allowed to enter the nostril, as they 
are almost canterant in power. Sometimes, where great excoriation 
of the alse of the nose exists, the too persistent use of the menthol 
may produce small herpetic spots about the nostrils. When menthol 
is inhaled for a long time or swallowed in any quantity it is apt to pro- 
duce severe congestive headache. 

Still another method is by the use of a nebulizer. (Fig. 52 ; also 
article on Inhalations, Part III.) The following mixture is placed in 
the glass jar, and the air being driven through the tube a vapor of 
the drugs is given off which is a valuable sedative to the entire respir- 
atory tract : 




Nebulizer. The small pump on the right 
side forces air through the black tube 
in the glass jar. This air escapes from 
an aperture in the side of the tube and 
draws up the medicated liquid, which. 
is then driven forcibly against the side 
of the glass. The finely comminuted 
fluid then passes as a vapor through the 
exit tube. 



R. — Chloretone gr. 

Menthol gr. 

Camphor gr. 

01. cinnamomi TT\,ij 

Petrolat. liquid . f % j 



0.13). 

1.3). 
(1.3). 
(0.13). 

(30.0; 



-M. 



S. — Use in a vaporizer every three hours for a period of about ten minutes. 



Menthol vapor is also useful in spasmodic croup. (See Part IV.) 
Emplastrum Menthol, B. P., is used as a mild local irritant and 
anaesthetic. 



23 



354 DRUGS. 



PEPSIN. 



Pepsinum, TJ. S. and B. P., is the digestive ferment of the gas- 
tric juice. That sold in the shops is generally derived from the pig, 
and is prepared by many persons in many ways. Much of the pep- 
sin of the market contains more peptone than pepsin, and much 
mucus and albumin. Used with hydrochloric acid in weak solution, 
pepsin carries out the digestive action of the stomach. Pepsin con- 
taining peptone has the peculiar musty smell of peptone, and if the 
peptone is in excess will absorb moisture and become sticky on ex- 
posure to the air. 

According to the TJ. S. P. of 1890, official pepsin must have the 
power to digest three thousand times its weight of albumin. 

Therapeutics. — Pepsin is a much-overrated remedy for indigestion. 
Pancreatin will always be found more serviceable, and should be given 
either immediately before or one or two hours after meals. Pepsin should 
be used immediately after the food is taken or with it. Hydrochloric 
acid should always be given with pepsin to aid its action, and be- 
cause it converts the pepsinogen in the gastric tubules into pepsin. 
Pepsin is official in the TJ. S. P. as Pepsinum and Pepsinum Saccha- 
ratum. The dose of the latter must be 20 to 30 grains (1.3-2.0) to 
be of service. It is an almost inert preparation, largely made up of 
milk-sugar. Liquor Pepsini is given in the dose of 2 drachms (8.0). 
Pure pepsin should be given in 5- to 15-grain (0.32-1.0) doses. A 
glycerite (Glycerinum Pepsinum) is official in the B. P. 

A very useful and readily taken liquid preparation is Pepsin Cor- 
dial, which is given in the dose of 1 to 2 drachms (4.0-8.0) after 
meals. A nutritious article of diet can be made by adding one tea- 
spoonful of this cordial to a half pint of warm milk, and allowing it 
to cool, thereby forming "curds and whey." (See Part III.) 



PERMANGANATE OP POTASSIUM. 

Potassii Permanganas, TJ. S. and B. P., is a salt of a dark pur- 
plish-red color, appearing in small crystals and readily soluble in 
water. In the presence of moisture it rapidly gives up the oxygen 
which it contains and becomes the binoxide of manganese. 

By reason of this oxidizing power the permanganate of potassium 
is useful as an antiseptic and deodorant. It should not be employed as 
a disinfectant for filth, because its action is too fleeting, but in satu- 
rated solution, followed by oxalic acid solution, it proves itself one 
of the best disinfectants for the hands in surgical practice. (See 
Antisepsis.) 

Permanganate of potassium is given in the same dose for amenor- 
rhcea as the binoxide of manganese, but is much less efficacious. It 
i- also very apt to irritate the stomach. 

The permanganate is thought to he useful in dyspepsia, flatulence, 
I it ha in ia. and obesity, and in the former states is certainly of service, 
being a destroyer of the abnormal products by oxidation. Owing to this 



PETROL A TUM—PHENA CETIN. 355 

oxidizing power, it has been asserted, by Weir Mitchell and Reichert, to 
be the most efficient antidote to snake-venom if placed in the wound 
before the poison is absorbed. It should also be injected hypodernii- 
cally about the seat of the bite. Permanganate of potassium is the best 
antidote in poisoning by morphine and that caused by many other 
vegetable alkaloids. Owing to its rapid evolution of oxygen, it acts 
as an antiseptic, and may be used in the washing of wounds, ulcers, 
and sores, and as a lotion in the form of a gargle or on a swab in the 
sore throat of diphtheria and scarlet fever. The solution used should 
be from 20 to 60 grains (1.3-4.0) to the pint (J- litre) ; the former is 
used on mucous membranes, the latter for sores and wounds. In foetid 
rhinitis and otitis media permanganate solution is useful as a wash in 
the proportion of 1 grain (0.05) to the ounce (30.0). When given in 
solution permanganate of potassium should be dissolved in distilled 
water, and it should never be mixed in a mortar with any organic 
matter, as it will explode. A solution {Liquor Potassii Permangana- 
tis) is official in the B. P. 



PETROLATUM. 

Under the name of Petrolatum Molle, U. S., or Soft Petrola- 
tum, or Unguentum Petrolei, is sold a semi-solid substance derived 
from certain kinds of petroleum, and sometimes called Cosmoline or 
Vaseline. 

Owing to its soothing powers and non-rancidity, it is used as an 
emollient dressing in sores and skin affections. It has no value 
except as a protective, and may be given in capsules in cases of gas- 
trointestinal irritation in any quantity as a soothing treatment. It 
does not affect the passages from the bowels and is not absorbed, 
although assertions to the contrary have been made. 

Cosmoline is a useful ointment base for medicines for the 'skin. 
Under the name of fluid or liquid petrolatum {Petrolatum Liquidum, 
U. S.) a fluid form is sold, which is much used in the form of a spray 
in the treatment of rhinitis and after irritant applications to the nasal 
cavities. 

The U. S. P. now recognizes, in addition to these two preparations, 
Petrolatum Spissum, which has the consistence of a cerate. 



PHENACBTIN. 

Phenacetin (Phenacetinum, B. P.) is a coal-tar product introduced 
several years ago as an antipyretic of the same character as antipyrin, 
and, while more apt to disintegrate the blood than the latter drug when 
given in large amounts, is not very dangerous, because its influence 
upon other vital parts is not severe. 

When this drug is carelessly made an impure product is the result, 
which produces irritation of the kidneys, and, in consequence, causes 
grave complications. Reuter states that the impurity may be dis- 
covered by placing a small amount of chloral hydrate in a test-tube, 



356 DRUGS. 

melting it at the temperature just sufficient to liquefy it, and then 
adding the suspected sample of phenacetin in the proportion of one- 
fifth. If the phenacetin is impure, it will become purple, then red, 
and finally blue. 

Physiological Action. — Unfortunately, our knowledge of the phys- 
iological action of phenacetin upon the nervous system is not as 
thorough as is desirable. We know, however, that it is a distinct 
nervous sedative, and that it acts particularly on the spinal cord in its 
sensory tracts. 

Upon the circulation the drug has little or no effect, unless given 
in doses far above those generally employed or continued in overdose 
for some time. The blood after the ingestion of these doses becomes 
dark and blackish from the formation of methgemoglobin, and the urine 
becomes dark yellow and reacts with Fehling's solution. Upon normal 
bodily heat and the heat of fever the drug exerts a depressing effect, 
decreasing the production and increasing the dissipation of heat. 

Therapeutics. — Our knowledge concerning the influence of phen- 
acetin upon the human body in disease may be divided into two 
separate parts in much the same manner that we divide the uses of 
antipyrin — namely, its uses as an antipyretic and as an analgesic. 

Like the other members of the antipyretic group which are blessed 
with this double action, its antipyretic influences were first observed, 
and shall therefore first be spoken of. 

The employment of this drug in medicine was first attempted by 
Hinsberg and Kast, who from the very first spoke of it in the highest 
terms of praise. They found that it seldom, if ever, caused serious 
untoward effects, and that its power over fever, in the dose of from 
3 to 8 grains (0.15-0.5), was quite extraordinary. Very shortly 
after the paper of these writers appeared Kohler published the 
report of its use in some fifty cases in the clinic of Bamberger of 
Vienna. He founcl, as have most of his successors, that the fall of 
fever does not occur for nearly half an hour after the dose is taken, 
and that the stage of apyrexia continues for from four to eight hours 
afterward. 

As a general rule, sweating is not noted as being present to any 
great extent, but in phthisis and advanced typhoid fever there can be 
no doubt that chilliness and an abnormal fall of temperature may 
come on under its influence. Cyanosis and vomiting did not occur in a 
single one of Kohler's cases. 

The remarks made in the article on Fever (Part IV.) clearly show 
why phenacetin should not be used as an antipyretic, for all antipyretic 
drugs are. as a rule, deleterious. It is far better to reduce the fever 
with cold applications. (See Cold in Fevers, Part III.) 

( ]><>]i the nervous system phenacetin acts as an antineuralgic, and is 
of service in migraine and ordinary headache from eye-strain, in the 
pains of tabes dorsalis, in intercostal neuralgia, and in rheumatism. 
Sometimes it cures these troubles when antipyrin fails. Altogether, 
we may consider phenacetin a rival of antipyrin in the power to 
relieve pain. 



PHENOCOLL— PHOSPHATE OF SODIUM. 357 

For neuralgia the following prescription may be ordered : 

R.— Phenacetin gr. x (0.65). 

Caffeinse citratis gr. v (0.35). 

Sacchar. lactis gr. xx (1.3). — M. 

Ft. in chart. No. v. 
S. — One powder every two hours while pain lasts. 

In subacute rheumatism and in the lumbar or muscular pains of 
influenza a powder or pill of 4 grains (0.3) of phenacetin and 5 grains 
(0.35) of salol given three or four times a day is most efficient. 

Under the name " Lactophenin" a nearly related compound of 
phenacetin is sometimes used for the same purposes. In phenacetin 
one atom of hydrogen is replaced by an acetic-acid radical ; in lacto- 
phenin this atom of hydrogen is replaced by a lactic-acid radical. 
Similarly " citrophen " is made by replacing the atom of hydrogen by 
a citric-acid radical. It is also used as a substitute for phenacetin. 

The dose of these drugs is about the same as that of phenacetin, 
or a little larger, about 5-10 grains (0.32-0.65) three times a day. 

t 

PHENOCOLL. 

Phenocoll is a compound closely allied to phenacetin. It is always 
used in the form of the hydrochloride of phenocoll, which occurs in a 
fine white powder, which is soluble in water and forms a neutral solu- 
tion. It is incompatible with alkalies, and is used as an antipyretic. 

Physiological Action. — A number of studies of the action of phe- 
nocoll hydrochloride upon the animal organism have been made by 
Robert and von Mering in Europe, and by Wood and Cerna and 
Ott in America. These investigators have found that it separates 
itself from most of the coal-tar antipyretics in that it has little effect 
on the red blood-corpuscles. It does not cause so great a sweat when 
the fever falls as do its near antipyretic relatives. Von Mering has 
shown that phenocoll has little lethal power, but Ott asserts that in 
poisonous dose it kills by failure of respiration, and causes paraplegia, 
cyanosis, and depression of the heart. 

Therapeutics. — As pointed out in the article on the treatment of 
Fever, antipyretic drugs are of little value as compared to bathing. 
Phenocoll may be given for the same purpose and under the same 
circumstances in the presence of fever as can antipyrin or acetanilid, 
but, like these drugs, is contraindicated in advanced exhausting dis- 
eases, such as consumption. A number of clinicians have tried pheno- 
ocll hydrochloride for the relief of acute rheumatism and to remove 
neuralgic pain, with asserted success. The dose of phenocoll hydro- 
chloride is 5 to 8 grains (0.35-0.6) two to five times a day. It is best 
given in capsule. 

PHOSPHATE OP SODIUM. 

Sodii Phosphas, U. S. and B. P., is a preparation which has been 
used with the idea that it can supplant phosphorus. This is, of course, 
an error, as it has an entirely different effect. It is particularly useful 



358 DRUGS. 

for bottle-fed children, who continually alternate between diarrhoea and 
constipation, and is also useful for rickets. It should be added to each 
bottle of milk in the dose of 2 to 4 grains (0.1-0.2). Phosphate of 
sodium in small doses is slightly laxative, and large doses are purga- 
tive. Bartholow believes phosphate of sodium to be the best remedy 
that we have in hepatic cirrhosis and jaundice. To adults it should 
be given in the dose of 20 grains to 2 drachms (1.3-8.0) once, twice, 
or thrice a day according to the laxative effect desired. 

Many cases of general wretchedness or headache due to an excess of 
uric acid in the blood are relieved by the acid phosphate of sodium or 
of calcium, since both substances cause the disappearance of the acid 
from the blood, not by causing its elimination, but by causing its 
deposit in the tissues in the form of urates. The continued use of 
these so-called acid phosphates is therefore ultimately harmful in gouty 
or rheumatic persons. 

The B. P. also recognizes a preparation called Sodii Phosphas 
Effervescens ; dose 2 to 4 drachms (8.0-16.0). 

(For an explanation of the purgative action of all salines see article 
on Magnesium Sulphate.) 

PHOSPHIDE OP ZINC. 

Zinci Phosphidum, U. S., is often used in place of phosphorus, 
owincr to its greater stability and readiness of administration. The 
dose i s J_ of a grain (0.006) three times a day. It is used in gela- 
tin-coated pills. 



PHOSPHORIC ACID. 

The pure acid is very rarely employed in medicine, but when 
given is used in 2- to 8-minim (0*1-0.5) doses. In the form of dilute 
phosphoric acid (Acidum Phosphoricum Dilution. U. S. and B. P.) 
it is widely employed in the dose of 20 minims to 1 drachm (1.3-4.0) 
as a tonic and gastric stimulant. It is not a food to the nervous sys- 
tem, does not resemble phosphorus in its physiological action, and is 
not to be employed in its place. It does good in nervous exhaustion 
simply by stimulating the stomach and thereby aiding that organ in 
the digestion of food. Phosphoric acid is also official in the B. P. as 
Acidum Phosphoricum Concentratum. 

PHOSPHORUS. 

Phosphorus. U. S. and B. P., is a non-metallic element, gener- 
ally obtained from bones, and is very soluble in oils, less so in ether 
and alcohol. Its odor is very characteristic and peculiar. When 
placed in a dark room after exposure to light it is luminous, and if 
exposed to the air will ignite. It should be kept in tightly-stoppered 
bottles under water. Very commonly it is contaminated by arsenic 
and sulphur. 



PHOSPHORUS. 359 

Physiological Action. — Phosphorus is found in large amount, com- 
paratively speaking, in the bones and in the nervous system, and is a 
stimulant to the growth of both. It acts, therefore, as a direct tonic 
to nervous tissue and is a producer of bone. Upon tissue-waste the 
drug acts as a depressant, thereby preserving the body, as it decreases 
the elimination of urea and diminishes the quantity of carbonic oxide 
exhaled. 

Upon the growth of bones phosphorus has a most remarkable 
influence, causing, when it is given to young animals, great increase 
in the size of these parts. The first change noted is an enlargement, 
which consists in a jelly-like mass containing little or no bone salts, 
and this is finally converted into a very hard material which may fill 
the entire canal in the centre of the bone. Kissel has stated that this 
does not occur, but his results must be doubted in view of the thorough 
studies of Wegner. 

Acute and Chronic Poisoning. — When phosphorus is taken in poi- 
sonous dose, often from the ends of matches, no symptoms may come 
on for eight or ten hours. At the end of that time the peculiar taste 
of phosphorus may be noted in the mouth, the breath is heavily laden 
with its odor, and burning pain in the oesophagus, stomach, and abdo- 
men becomes a pressing symptom. Vomiting and purging now assert 
themselves, and both the matters which are vomited and those which 
are passed from the bowels may be luminous in the dark, owing to the 
presence of phosphorus. The vomit at first consists of food, then 
mucus, then bile, and then perhaps blood. All the symptoms of a mild 
gastro-enteritis may develop, but it is to be noted that constipation of 
an obstinate type may be present instead of purging. Very soon the 
liver increases in size, and gives rise to general hypochondriac pain and 
tenderness as w T ell as local swelling. At the end of twenty-four hours, 
or perhaps after the second day, a cessation in the symptoms occurs, 
and, if the physician be not on his guard, this will lead him to a hope- 
ful prognosis, but in the course of a few hours jaundice begins in the 
conjunctiva and then extends over the entire body. With the onset 
of jaundice the vomiting and pain return with renewed vigor. The 
matters vomited are often the color of " coffee-grounds," due to exuded 
and altered blood. The bowels are absolutely confined, or the few 
hard masses of fecal matter which are passed are white and clay-like 
because of the absence of biliary coloring matter. There is no bile 
in the vomit in this stage, because the hepatic ducts have been closed 
by the inflammation which has been produced in the liver. Later, 
nervous symptoms ensue. Muscular twitchings, headache, vertigo, 
wild delirium, erotic convulsions, and finally unconsciousness and death, 
occur. Sometimes the convulsions occur just before dissolution. Even 
if the patient survives the acute stage of the poisoning, he generally dies 
of the changes produced in his vital organs, which consist in wide- 
spread fatty degeneration. These fatty changes occur even in the 
acute form of the poisoning. Atrophy of the liver, destruction of the 
gastric tubules, pancreatic involvement, and kidney degenerations aid 
in producing the ultimately fatal results. 

During the poisoning by phosphorus the urine is scanty and per- 



360 DRUGS. 

haps albuminous, and is peculiar because of the unusual substances 
which are found in it. The most unusual of these is sarcolactic acid, 
which results from the breaking down of the muscular tissues. Leucin 
and tyrosin are also found, and tube-casts with fatty globules in them 
are seen. Free fat-globules may also occur. Bile acids and bile col- 
oring matter are found in large amount, and the urine is generally 
dark-colored for this reason. As phosphorus is eliminated in the urine 
as hypophosphoric acid, this substance is also present. 

The symptoms of phosphorus poisoning may so closely resemble 
those of acute yellow atrophy of the liver as to make a differential 
diagnosis impossible, unless some evidence of the presence of phos- 
phorus is obtainable. 

In chronic poisoning by phosphorus, when, by the inhalation of its 
fumes, systemic changes occur, the most common lesion is necrosis of 
the lower jaw, which may be widespread or limited. It never occurs 
in those who have no solution of continuity in the teeth or gums, and for 
this reason it is necessary that the employes in match-factories should 
have their teeth and gums constantly attended to. It has been said 
that pans containing turpentine when set around the work-room will 
protect the workmen, but this is certainly incorrect. 

Treatment of Acute Poisoning. — The antidote to phosphorus is 
generally taught to be the sulphate of copper, which will also act as an 
emetic if given in excess, but recent studies made by Thornton in the 
laboratory of Jefferson Medical College prove that it is as dangerous 
a poison as the phosphorus. Peroxide of hydrogen and permanganate 
of potassium are probably the best antidotes. Oil of turpentine, in 
America, is not only valueless as an antidote, but harmful, for only 
old, ozonized French oil of turpentine is antidotal in its influence. 
As phosphorus is soluble in oils, we simply aid in its absorption if 
any such substances are given. 

Therapeutics. — Owing to its influence on the development of bone, 
phosphorus is very useful in rachitis and osteomalacia. It is also 
useful in the sweats of general or nervous debility and in nervous 
exhaustion, and in some cases of melancholia depending upon over- 
work. In the course of prolonged exhausting diseases, as typhoid 
fever or typhoid pneumonia, the drug is of service if the nervous 
system seems to be particularly affected, and in convalescence it is of 
service in aiding to build up the shattered forces of a patient. 

In the sequelae of acute and chronic alcoholism and in morphio- 
mania it is of service. Phosphorus is also employed in sexual 
exhaustion or abuse. In boils and carbuncles and similar disorders 
phosphorus is very useful, particularly so in acne indurata. In pneu- 
monia some physicians use minute doses with the belief that it aids in 
the production of resolution. Probably it does good in these cases 
by stimulating or supporting the nervous system. 

In the neuralgia from nerve-depression and in cerebral softening 
and meningitis of a chronic type phosphorus may be given with 
advantage. 

The dose of phosphorus is T / nr to ^ of a grain (0.0006-0.0012) 
in pill form {Pilulce Phosphoric U. 8. and B. P.), but it may be grad- 



PHYSOSTIGMA. 361 

ually pushed to -^ of a grain (0.003) if urgently needed. Phospho- 
rated oil {Oleum Phosphor atum, TJ. S. and B. P.) and Spiritus Phos- 
phor^ TJ. 8., are given in the dose of 1 to 5 minims (0.05-0.35). 
Elixir Phosphori ( TJ. S.) is given in the dose of 15 minims to 1 
drachm (1.0-4.0). 

The beginning dose of phosphorus should not be above T ^- of a 
grain (0.0006), for fear of some idiosyncrasy. 

PHYSOSTIGMA. 

Physostigma, TJ. S. {Physostigmatis Semina, B. P.), is a seed 
derived from Physostigma venenosum, a tree of West Africa, often 
called Calabar bean. It contains two alkaloids, eserine or physostig- 
mine and calabarine. The former is the most important from a med- 
ical point of view. 

Physiological Action. — When a moderate dose of physostigma is 
given by the mouth it often produces some pain in the stomach and a 
sense of oppression and weakness. The pulse becomes slow, the respi- 
ration is depressed, and the pupils are contracted. Calabar bean in 
poisonous dose is a general paralyzant, but if the alkaloid calabarine 
be present in excess, it may be a convulsant. 

Nervous System. — On the spinal cord in poisonous dose this drug 
acts as a depressant poison, particularly affecting the sensory tracts. 
On the motor nerves it exerts no influence unless given in toxic doses, 
when it depresses their peripheral ends. The sensory nerves escape, but 
sometimes even they are involved. On the voluntary muscles the drug 
in these doses causes twitchings. In medicinal doses the drug is a stim- 
ulant to unstriped muscular fibre and acts as a mild nervous sedative. 

Circulation. — Calabar bean causes little circulatory change, but 
poisonous doses at first produce a rise of arterial pressure, due to a 
direct stimulation of the heart and of the muscular coats of the vessels. 
It slows the pulse by peripheral stimulation of the vagi. In medicinal 
dose its circulatory effect is not marked, but is depressant rather than 
stimulant. 

Respiration. — In moderate amount Calabar bean does not affect 
respiration, but in poisonous dose it produces death by paralysis of 
the respiratory centre. 

Pupil. — Physostigma causes myosis or contraction of the pupil by 
stimulation of the oculo-motor nerves peripherally, but not by depres- 
sion of the sympathetic fibres, and by causing contraction of the blood- 
vessels of the iris. It decreases intraocular tension, produces tempo- 
rarily an increase in the power of accommodation for near objects, and 
then causes spasm of accommodation. The myosis usually develops in 
about eight to fourteen minutes after the drug is dropped into the eye, 
and reaches its maximum in thirty minutes, lasting for from six to 
eight hours. The partial influence may last, however, for from four 
to five days. 

Alimentary Tract. — Physostigma is a stimulant to intestinal 
peristalsis, increasing the muscular activity in the walls of the gut 
and acting as a tonic to these fibres. 



362 DRUGS. 

Poisoning. — Poisonous doses of physostigma cause muscular trem- 
ors, followed by complete muscular relaxation. The pupils contract, 
the respirations become slow and irregular, and all reflex action fails. 
Vomiting or purging may or may not occur. 

Treatment of Poisoning. — This consists in the use of atropine, 
which is the physiological antidote, in the application of heat to the 
body, and the use of respiratory and cardiac stimulants, such as digi- 
talis, alcohol, or ammonia. 

Therapeutics. — Calabar bean has been employed in many affections, 
such as trismus neonatorum, tetanus, and other spasms, with only 
moderately good results. It is, however, of value in atony of the 
bladder and intestines and in catarrh of the bowels. The author has 
used it with advantage in cases of gastric and intestinal dilatation, 
combined with nux vomica. Some physicians think it of value in 
cases of tympanites, but in a limited use of it in certain severe 
cases of pneumonia with tympanites the writer has not found it of 
value. 

In bronchial asthma and emphysema it aids in the expulsion of 
the mucus by its influence over the muscular fibres in the walls of the 
air-tubes. It is also useful in purgative pills to stimulate the mus- 
cular fibres of the intestine. (See Constipation.) 

Administration. — Physostigma is used in the form of the extract 
{Extractum Physostigmatis, TJ. S. and B. P.) in the dose of J of 
a grain (0.008). which may be readily increased to \ of a grain 
(0.016). 

The tincture {Tinctura Physostigmatis, TJ. 3.) is given in the dose 
of 5 to 20 minims (0.3-1.35). This tincture is twice as strong as that 
official in the TJ. S. P. of 1880. 

Eserine is usually employed in the form of one of its salts. Phy- 
sostigmince Salicylas, TJ. S., and Physostigmince Sulphas, TJ. S. and 
B. P., may be used in the dose of -^ of a grain (0.0008) three times 
a day. The sulphate is much more soluble, and is generally to be 
employed. The salicylate is largely used, nevertheless, by ophthal- 
mologists. In the eye, in the strength of 1 to 2 grains to the ounce 
(0.05-0.1 : 30.0) of water, eserine is used in the treatment of corneal 
ulcerations, for the relief of glaucoma, and to diminish high intra- 
ocular tension. If, for any reason, atropine mydriasis is to be rapidly 
overcome, eserine may be used, but it is not so powerful a myotic as 
atropine is a mydriatic, and it requires larger amounts of the solution 
-to produce contraction than it took of atropine to cause mydriasis. 
Lainclhe Physostigmince, B. P., each contain y^g-^- of a grain (0.00006) 
of phvsostigmine sulphate. The dose of both salts of eserine is iqO ' Vo 
of a grain (0.0006-0.0008.) 



PICRIC ACID. 

Picric Acid or Trinitrophenol occurs in light-yellow scales or 
needles without odor, and is chiefly used in the arts as dye. Its 
uses in medicine are very limited. Recently it has been found exceed- 



PILOCARPUS. 363 

ingly efficacious in solution in the treatment of burns and scalds. 
This solution is made as follows : 

R. — Acid, picric gr. Ixxv (5.0). 

Alcohol f^iiss (75.0). 

Aquse destillatae Oij (1000 c.c). — M. 

After the burn is cleansed of dirt and charred clothing, strips of ster- 
ilized gauze are soaked in this solution and applied to the part. Over 
this is placed a pad of dry absorbent cotton which is fastened by a light 
bandage. The dressing rapidly dries, and may be left in place for 
several days. It is then moistened with the solution so as to soften it, 
is removed, and then a fresh dressing is applied for a week. All blis- 
ters should be pricked. This dressing relieves pain, stops suppuration, 
and leaves a smooth cicatrix. 



PILOCARPUS. 

Pilocarpus, TJ. S. (Jaborandi Folia, B. P.), is derived from the 
South American tree, Pilocarpus Selloanus or Pilocarpus Jaborandi. 
It contains two alkaloids, known as pilocarpine and isopilocarpine. 
Jaborine is a combination of these alkaloids and a resinous substance. 
The alkaloid pilocarpine is non-crystallizable and occurs as a soft 
mass, but the salts of pilocarpine are crystallizable. 

Physiological Action. — When jaborandi is taken in medicinal dose 
by a healthy man, it causes a deep flushing of the face and neck, fol- 
lowed by the outbreak of a profuse sweat, which, though beginning 
in these regions, rapidly spreads over the entire body. Accompany- 
ing the sweat, the salivation is often exceedingly profuse, so that 
saliva dribbles from the mouth. The sweat lasts from two to five 
hours. Nausea frequently comes on, and severe vomiting may appear 
in susceptible persons either during or after the sweating. Some 
individuals are singularly insusceptible to the diaphoretic influence of 
pilocarpus, and this is particularly so, according to Ringer, with chil- 
dren, who will often take as much as 60 grains (4.0) of the crude 
drug before they perspire. 1 

Nervous System. — Moderate doses given to men have no effect 
on this part of the body. 

Circulation. — In large doses there is no doubt that jaborandi 
acts as a cardiac depressant rather than a stimulant. The drug causes 
in the lower animals a slow pulse and decreased arterial pressure, in 
moderate quantities, the first change being due to an action on the 
inhibitory centres in the heart or on the peripheral vagi. (See Fig. 
53.) In man the drug does not slow the pulse, but quickens it very 
markedly, often as much as forty to fifty beats per minute. Although 
the pulse in animals is generally made stronger from its use, in man 
it is generally made weaker. 

1 The writer has reported a case (see Idiosyncrasy) in which a woman of thirty 
years received f of a grain of the muriate of pilocarpine hypodermically in half an 
hour without any effect. 



364 



DRUGS. 



Stomach. — Jaborandi sometimes produces nausea and vomiting by 
irritating the stomach and perhaps the vomiting centre. 

Temperature. — Jaborandi lowers bodily temperature to a con- 
siderable degree, probably by the dilatation of the peripheral capil- 
laries and the profuse sweat which it produces. This fall is some- 
times preceded by a brief rise. 

Kidneys and Tissue-waste. — Upon the kidneys jaborandi acts 
very slightly or very strongly, according to the dose that is given. 
Large doses, which produce a profuse sweat, naturally decrease the 

Fig. 53. 



AxfWVWA/ 



II 



III 



IV 




Parts of a tracing showing the effect of pilocarpine in depressing blood-pressure, and the stim- 
ulant effect of atropine upon blood-pressure in the circulation of a dog. (After Schmiede- 
berg.) I. Shows the pulse-rate and blood-pressure unaffected by drugs. II. Pilocarpine 
injected, which slows the pulse from 28 in ten seconds to 19 in ten seconds, and lowers 
the blood-pressure from 126 to 96. III. Further depression and slowing: pressure, 70. 
IV. Atropine given, which raises blood-pressure to 145 and pulse-rate to 30. 



miliary secretion, but small ones undoubtedly increase it. Upon the 
tissue-changes in the body under pilocarpine no researches have been 
made, but it is an undoubted fact that in disease the excretion of urea 
is largely increased under the influence of this drug. 

EYE. — Jaborandi contracts the pupil by stimulating the peripheral 
ends of the oculomotor nerve in the iris. 

Skin \\i> Secretion. — The amount of sweat caused by the drug 
in man may equal as much as a pint, and it is generally first acid, from 
the secretions of the sebaceous glands, then neutral, and finally alka- 



PILOCARPUS. 365 

line. The sweating is not primarily due to vasomotor palsy, but to 
stimulation of the ends of the nerves supplying the glands and of the 
sweat-glands themselves. The sweat usually lasts about two to five 
hours. Sometimes excessive salivary secretion supplants that of the 
skin. 

Pilocarpine increases the gastric, salivary, and lachrymal secretions, 
as well as that of the skin and kidneys. It also seems to have con- 
siderable influence over the secretion of milk. 

Therapeutics. — Jaborandi, or, better still, its alkaloid, pilocarpine, 
is of some value for the relief of dropsy of the renal type. In that 
due to cardiac disease it is generally too depressing, and the author 
knows of a case in which a fatal result speedily followed its use under 
these circumstances. It may be used to abort an attack or paroxysm 
of malarial fever, but because of its depressant influence should never 
be employed in asthenic fevers, such as typhoid fever. In 'pleurisy with 
effusion it may be used, but more efficient remedies are elaterium, or 
salines given in concentrated form and at the proper time of the day. 
(See Magnesium Sulphate and Dropsy.) Better than all these is 
thoracentesis. Spaulding and de Schweinitz have both recommended 
very highly the hypodermic use of pilocarpine in the dose of ^ to 
Y 1 ^- grain (0.005-0.006) a day for opacities of the vitreous humor of the 
eye. The fluid extract of jaborandi may be employed, but is apt to 
nauseate the patient. Diaphoresis should not be produced. Because 
of its myotic influence on the pupil pilocarpine is of very great value 
in the treatment of all conditions of the eye associated with increased 
intraocular pressure. It is so good a myotic as to be rapidly supplant- 
ing eserine for this purpose with some clinicians. The strength of pilo- 
carpine solution for this purpose is 1 to 4 grains (0.06-0.25) to the 
ounce (30.0). It should be dropped into the eye, 1 or 2 drops at a 
time, every hour until the patient is relieved. Pilocarpine is also use- 
ful as an ocular tonic to relieve eye-pain after excessive use of the eyes, 
in the strength of -^ grain (0.006), to the ounce (30.0). A few drops 
of this solution may be dropped into the eye three times a day. This 
solution should have a little boric acid (4 grains) added to it to prevent 
fungus growth. (See Asthenopia.) Clinical reports show that pilo- 
carpine in small doses is a very good remedy in tobacco and alcoholic 
amblyopia. 

Mitkowski has tried pilocarpine in catarrhal jaundice of a persistent 
type with great benefit, in the hypodermic dose of J grain (0.01) every 
other day for three weeks. In urosmic poisoning pilocarpine is theoreti- 
cally the most efficient and rapidly acting remedy that we have, and when 
used in BrigMs disease it may be of value in several ways — first, by 
removing the strain on the kidneys ; second, by eliminating the ursemic 
poison ; and third, by decreasing the inflammatory condition in the 
kidneys by lowering the blood-pressure, which, it will be remembered, 
is the more constant effect of the drug in man. Care should always be 
used in the use of the drug lest cardiac depression ensue, and alcohol 
or strychnine may often be used with advantage to guard against this 
accident. The general consensus of opinion is that in the nephritis of 
middle years or advanced life with cardiac changes it is contraindicated. 



366 DRUGS. 

The author never uses it in chronic renal disease of the parenchyma. 
In the uremic convulsions of pregnancy pilocarpine, while theoretically 
useful, has been proved by experience to do more harm than good 
through its depressing influences, although the drug in small doses cer- 
tainly increases renal activity. The hypodermic dose of pilocarpine as 
a renal stimulant should be about -^ to -^ of a grain (0.002-0.003). 
In some forms of profuse sweating, such as come on at night in cases 
of general debility, pilocarpine, if given hypodermically or by the 
mouth about two hours before the sweat in the dose of -^ of a grain 
(0.003), is often useful even where atropine fails. The good effect is 
produced by stimulating the sweat-glands and so overcoming their 
atony. 

DaCosta, Salinger, and Barr have highly recommended the hypo- 
dermic injection of pilocarpine in erysipelas as a preventive and cura- 
tive measure in the early stages of this disease, and their reports are so 
encouraging as to warrant a careful trial of the method. The proper 
dose is -J- grain (0.01) every three hours until free sweating ensues. 
After this is accomplished the doses may be repeated every four or six 
hours. The author would fear that such active treatment might 
seriously affect the strength of the patient unless stimulants were also 
used. 

In cases of obstinate aural vertigo a most efficient treatment is the 
hypodermic use of pilocarpine every few days in sufficient dose to pro- 
duce some salivation. The patient has to lie down or go to bed after 
the dose is given. 

Pilocarpine certainly has a decided effect in encouraging the growth 
of hair, and applied locally will often do good in partial baldness. If too 
much pilocarpine is used, it is apt to cause the development of small 
pustules about the hair-follicles. Bartholow recommends the following 
application for baldness : 

R.— Extract, pilocarpi fluid f.^j (30.0). 

Tincture cantharidis . f.^ss (15.0). 

Liniment, saponis fjvi ss (45.0). — M. 

The author has found the following prescription very efficacious 
in falling of the hair : 

R.— Extract, pilocarpi fluid f.^j (4.0). 

Tr. capsici f£j (30.0). 

Tr. cantharidis f^ss (2.0). 

Ol. ricini f.^j (4.0). 

Alcohol q. s. fgiv (120.0).— M. 

S. — Apply with friction in spots to the scalp, night and morning. 

Antagonisms of Jaborandi. — Jaborandi is a physiological antidote 
to atropine and to agaricin. Four times the dose of pilocarpine must 
be used to equal a dose of atropine. Vomiting produced by pilocarpus 
is to be antagonized by morphine. 

Untoward Effects. — Dimness of vision, vomiting, and sudden col- 
lapse, Swelling of the salivary glands and tonsils, hiccough and strang- 
ling are sometimes met with after using pilocarpus. Sometimes bloody 
leucorrhcea is seen. The vomiting can usually be prevented by full 
doses of chlorodyne. 






PIPERAZINE. 367 

Prentiss has called attention to the fact that the continued use of 
pilocarpine may cause the hair to become coarse and dark. 

Administration. — The dose of jaborandi is 40 grains (2.65), used 
in the form of the powdered leaves in infusion. The fluid extract 
(Pxtr actum Pilocarpi Fhcidum, U. S., JExtr actum Jaborandi Liqui- 
dum, B. P.) should be used in the dose of 10 minims to 30 minims 
(0.65-2.0). Pilocarpine is far superior to jaborandi, in that it does 
not so often produce nausea and vomiting. It is used in the form of 
the hydrochlorate (Pilocarpine Hydrochloras, TJ. S.), in the dose of 
from J- to J of a grain (0.008-0.03) hypoderarically, or J to J of a 
grain (0.015-0.03) by the mouth. 

The additional preparations of the B. P. are — the tincture (Tinc- 
tura Jaborandi), dose \ to J fluidounce (8.0-15.0); and the nitrate 
of pilocarpine (Pilocarpine Nitras), \ to J grain (0.008-0.03). 



PIPERAZINE. 

This is a substance, the chemical formula of which is C 4 H I0 N 2 , 
which has been recently introduced into medicine for the treating of 
the uric-acid diathesis. It is not stable, and when exposed to the air 
attracts water and carbonic acid. Aqueous solutions are decidedly 
alkaline, but do not have any distinct taste. 

Piperazine is peculiar in its power to dissolve uric acid, dissolving 
twelve times as much as will carbonate of lithium, while it is also 
entirely soluble in water, which lithium is not. When taken into the 
body the drug is partly oxidized and partly eliminated unchanged. 
Theoretically, piperazine, when taken into the body, forms with uric 
acid a urate of piperazine, which is soluble and readily eliminated. 
Experiments have been made to determine this point with very satis- 
factory results, but repeated clinical observation has shown that the 
administration of the drug causes an increase in the amount of urea 
in the urine with a decrease in the uric acid, indicating that under its 
influence oxidation is more complete. 

Therapeutics. — Piperazine is used for the purpose of preventing the 
formation of renal and vesical calculi in the uric-acid diathesis, and 
also in cases where the excess of uric acid in the urine tends to pro- 
duce irritation of the bladder. Similarly, its action has been found 
of value in treating vesical irritation due to this cause by washing out 
the bladder with a solution of piperazine of the strength of 1 per cent. 
Piperazine has also been injected into uric-acid deposits about the 
body or applied to the broken-down surfaces of these deposits in 1 
per cent, solution, but the author has not been favorably impressed 
with this method, and would advise against its use — first, because it 
does little if any good, and, second, because the method is painful 
and apt to cause sloughs by interfering with nutrition of the skin, 
which is already lacking in health. 

The dose of piperazine is 15 grains (1.0) in twenty-four hours. It 
is best given by dissolving this amount of the drug in 1 pint (-J- litre) 
of water, and directing the patient to take a wineglassful of the solu- 



368 DRUGS. 

tion frequently through the day. Owing to the effect upon the drug 
of exposure to air, it cannot be given in pill or powders, and should 
be freshly mixed each day. The writer has failed to obtain any 
results from the use of this drug in his practice. 

Stewart has noted, as untoward effects of full doses of piperazine, 
tremors, hallucinations, and clonic spasms. 

Lycetol is a substance closely allied to piperazine, and is used in 
medicine for the same purposes. Dissolved in water it has a taste 
somewhat like lemonade. Unlike piperazine, it is not hygroscopic and 
will keep indefinitely. The dose of lycetol is 15 to 30 grains (1.0-2.0) 
a day, well diluted with water, to which a little sugar may be added to 
improve the taste. Usually it is best to give the drug in carbonated 
water, and to begin with small doses, which are to be gradually increased 
in size. 



PISCIDIA ERYTHRINA. 

Piscidia Erythrina is a drug which is stated to possess marked nar- 
cotic and pain-relieving properties. It is sometimes called Jamaica 
dogwood. Its powers as a soporific and analgesic do not compare 
with those of opium, but it is stated to be devoid of the unpleasant 
after-effects of the latter drug. Further studies concerning its effects 
on the animal economy are needed. According to Dr. Isaac Ott and 
Dr. Nagle, the drug has little or no effect on the motor and sensory 
nerves, and its dominant effect on the circulation is to increase arterial 
pressure through stimulation of the vasomotor system. The indica- 
tions which have been met best by piscidia are dysmenorrhea due to 
irregular flow and spasm of the uterine cervix and fundus, to allay 
nervous irritability, and to relieve pain or insomnia due to pain. 

Administration. — The dose of the fluid extract of piscidia erythrina 
is \ to 2 drachms (2.0-8.0); of the solid extract, 2 to 10 grains (0.1- 
0.65). The alkaloid piscidine is not known to represent all the prop- 
erties of the drug, and is not used in medicine. 



PITCH. 

Pix is a resinous exudation derived from several species of pines, 
firs, and spruces, and is, in one of its forms, obtained by the evapora- 
tion of wood-tar. It is used for various purposes, according to its deri- 
vation. Burgundy Pitch {Pix Burgundica, U. S. and B. P.) is derived 
from Norway spruce, or Abies (Picea, B. P.) excelsa, a plant of Europe 
and Asia. It softens and melts at the temperature of the body and is 
useful for plasters. Jnmuscular rheumatism and in chronic bronchitis 
pitch is a mild and fairly useful local remedy for external use. In the 
Form of the plaster {Emplastrum Picis, B. J'., Burgundies, U. 8.) 
and in the form of warming plaster {Mmplastrum Picis Qanthari- 
datum, U. S.) it is employed for the relief of deep-seated sprains and 
bruises^ and acts as a mild counter-irritant, which may blister a tender 
skin. Canada Pitch (Pix Canadensis) is obtained from the hemlock 



PITCH. 369 

spruce of Canada and the United States, and is used for the same 
purposes as Burgundy pitch. The Canada-pitch plaster [Emplastrum 
Picis Canadensis) is employed for the same conditions as the plaster 
of Burgundy pitch. 

Tar. 

Under the name of Pix Liquida, U. S. and B. P., or Tar, we have an 
empyreumatic oleoresin obtained by destructive distillation from Pinus 
palustris (Sylvestris, B. P.) and other varieties of pine. It is a thick, 
dark oil, slightly soluble in water and soluble in alcohol, oils, and solu- 
tions of potassa and soda. By distillation of tar we obtain oil of tar 
(Oleum Picis Liquidce, U. S.), which is sometimes used for bronchitis by 
inhalations from an atomizer, but is not a particularly useful application. 
It should be diluted with some other oil or with fluid cosmoline. Tar 
itself is used in subacute and chronic bronchitis in 2-grain (0.1) pills and 
as a remedy for g astro-intestinal catarrh. Externally, it is used in 
psoriasis and other skin diseases needing stimulation. For the relief 
of obstinate diarrhoea Wood has highly recommended a mixture of tar 
made as follows : Add a pint of tar to a gallon of lime-water, and allow 
this solution to stand one week, stirring it every few hours. Decant 
the clear liquid and percolate it through powdered wild-cherry bark, 
allowing 1 ounce of the bark to be present for each pint passed 
through it. The dose is a wineglassful (30.0). 

In chronic bronchitis tar-water is largely used, as a popular rem- 
edy, in Europe and England. Tar-water is made by shaking 1 part 
of tar with 4 parts of water several times during twenty-four hours, 
decanting, and filtering. The dose is from 1 to 2 pints (J-l litre) 
a day as a drink. It at first increases the expectoration, but finally 
decreases it. 

Syrup of Tar (Syrupus Picis Liquidce, IT. S.) is simply sweet- 
ened tar-water. 

In skin diseases of the dry, scaly sort, such as psoriasis, tar oint- 
ment ( Unguentum Picis Liquidas, JJ. S. and B. P.) is very useful if 
frequently applied, or the following may be used : 

R.-Sulphur.pr^cipitat.\ aa 5 vj (23.0). 

Picis Iiquiute | ° J v ' 

Saponis viridis ") __.-,.. , ac . n , 

Adipis } aa ^ ( 60 -°)- 

Pulv. cretse ^iv (15.0). 

If the skin is tender, this prescription should be diluted with lard. 
Sometimes children will suffer from a persistent dry chronic eczema 
which resists all treatment ; the following may then be employed with 
advantage : 

R.— Picis liquid ^ss (2.0). 

Sulphur, prsecip gss (2.0). 

Unguent, zinc, oxidi % j (31.0). 

S. — Apply night and morning. 

Tar should not be used on the face, as it will stain the skin. 
Wine of Tar (Vinum Picis) is made by adding together tar 1 

24 



370 DRUGS. 

pint, glycerin, white wine, and honey, of each -|- a pint, dilute acetic 
acid 1 ounce, and 3 quarts of boiling water, and shaking constantly 
at a temperature of 160° F. for several hours. It is then set aside 
to stand for some days and repeatedly filtered or strained through 
muslin. The dose is 1 to 4 ounces (30.0-120.0). It may be used 
instead of tar-water or tar-syrup. 

PODOPHYLLUM. 

Podophyllum, U. S., .May Apple or Mandrake, is the rhizome 
and small roots of Podophyllum peltatum, a plant of the United States 
and Canada. Podophyllum contains a resin, podophyllin. 

Therapeutics. — Podophyllum is the slowest-acting purge official in 
the Pharmacopoeia. In small doses it is laxative, but is purgative and 
almost drastic in larger amounts. In overdose it may produce gastro- 
enteritis. The drug particularly excites the flow of bile, and is used as a 
cholagogue. It is best given when the stools are dark in color, calomel 
being indicated when they are light. The author has found the follow- 
ing prescription useful in cases of intestinal flatulence and indigestion 
with constipation : 



B .—Podophyllin . 
Euonymin . , 
Leptandrin . . 
Ext. chiratffi . 
Creasotee . . 
Ft. in pil. Xo. xx. 



gr. v (0.32). 
gr. v (0.32). 
gr. v (0.32). 
gr. xlv (2.8). 
gr. x (0.65).— M. 



In children one or two months old who have hard, stony stools podo- 
phyllin is a good remedy. The dose should be given by dissolving a 
grain of the resin in a drachm of alcohol and using 2 drops or more 
of this on sugar once or twice a day. In children who suffer from 
summer diarrhoea, in which the passages consist almost entirely of 
water, which have a peculiar musty smell or a mouse odor, podophyllin 
in the dose of -g 1 ^ to -fa of a grain (0.001-0.0012), repeated every few 
hours, is of service, seeming to control the passages and make them 
normal. This treatment will often succeed when all else fails. This 
statement is also true in regard to the chronic diarrhoeas of adults, 
though the drug should be given in somewhat larger amounts in such 
cases. Podophyllin will also check vomiting in these doses in some 
instances, provided that the stomach is depressed and the liver is tor- 
pid. It should not be employed if the vomiting is due to irritation 
or inflammation of the stomach. 

Administration. — Podophyllum is used in the form of the extract 
Extractum Podophylli, U. &), dose 1 to 5 grains (0.05-0.35) ; the 
fluid extract (Extractum Podophylli Fluidum, U. S.), dose 2 to 20 
drops (0.1— 1.3) ; and, more commonly than all, as the liesina Podo- 
pliylli. U. 8. and B. P., or podophyllin, which is the best preparation. 
The dose of this preparation is from fa to y 1 ^ of a grain (0.003-0.006) 
as a feeble laxative, and from fa to J a grain (0.000-0.03) as a purge. 
The tincture of the resin (Tinetura Podophylli, B. J\) is given in the 
dose of 5 to 15 minims (0.3—1.0). 



POMEGRANATE. 371 



POMEGRANATE. 



Although Granatum, U. S. (Granati cortex, B. P.), is official, it is 
almost never used in America in its crude form. It contains an alka- 
loid known as pelletierine, this alkaloid being a colorless liquid, soluble 
in 20 parts of water and readily miscible with ether, chloroform, and 
alcohol. When acids are added to it it forms crystalline salts, of 
which four are used — namely, the tannate, the sulphate, the hydrobro- 
mate, and the hydrochloride. The first is most commonly employed, 
and is a yellowish powder possessing an astringent taste. It is soluble 
in 700 parts of water and 80 of alcohol. Its physiological action 
needs further investigation, but the drug in poisonous amounts para- 
lyzes the peripheral ends of the motor nerves in a manner closely 
resembling the action of curare. Sensibility is preserved. The loss 
of power is chiefly manifested in the lower limbs, in which at first 
there may be cramps. There may also be nausea and vomiting. 

Therapeutics. — Originally, pomegranate was largely used in the form 
of the rind of the fruit in decoction as a vegetable astringent, but 
this practice has ceased because of its disagreeable taste and effect upon 
the stomach. The ailments which were supposed to indicate its em- 
ployment were serous diarrhoea and profuse sweats. In some tropical 
countries the bark of the root is used as a vermifuge, and it is very 
efficient in removing the tape-ivorm. It is said that the bark of the 
root of the wild shrub is much more efficacious than that of the cul- 
tivated and more handsome plant. To be efficacious the dose of the 
decoction of the bark must be large. The drug is prepared by soak- 
ing 2 ounces (62.0) of the bark in 2 pints (1 litre) of water for 
twenty-four hours and then boiling down to a pint (J litre). A wine- 
glassful (30.0) of this is the dose which is generally given, and it may 
be repeated every hour until the whole amount is taken. The objec- 
tion to this line of treatment is that it is unnecessarily severe, often 
purging and vomiting the patient excessively. The nausea produced 
is often great. Should purging fail to appear, it is necessary to give 
castor oil or other purge to dislodge the worm, and it is always neces- 
sary to starve the patient for twelve hours before the remedy is tried. 

The dose of pelletierine is 3 to 5 grains (0.25-0.35), and the tan- 
nate is the salt usually employed. Practically, the only pelletierine 
used is that of Tanret, and his preparation is a syrupy solution in 
each bottle of which is one dose of the drug. 

As large doses as 20 grains (1.3) of pelletierine have been used, 
but as very serious paralytic symptoms have ensued after the inges- 
tion of 5 grains by a susceptible woman, not more than this amount 
should be given. When pelletierine is used it should always be fol- 
lowed in two hours by a purge. Those who have used it most place 
great reliance on it. 

The B. P. contains one official preparation of pomegranate — 
namely, the Becoctwm Granati Corticis, the dose of which is 1 to 2 
fluidounces (30.0-60.0). 



372 DRUGS. 



POTASSIUM BICARBONATE. 

This salt (Potassii Bicarbonas, U. S. and B. P.) is used for the 
same purposes as the citrate and acetate of potassium, and, as it is 
much less agreeable in taste, should not be employed when they can 
be obtained. From the bicarbonate of potassium are made several 
very useful preparations : the liquor potassii citratis, by adding 120 
grains (8.0) to 90 grains (6.0) of citric acid and 10 ounces (300.0) of 
water; the neutral mixture, by adding to 1 pint (500.0) of lemon-juice 
enough of the potassium salt to neutralize it. The dose of potassii 
bicarbonas is 5 to 40 grains (0.3-2.6), or even as much as 2 drachms 
(8.0) may be given if well diluted with water. 



POTASSIUM BROMIDE. 
(See Bromide of Potassium.) 

POTASSIUM CARBONATE. 

Carbonate of Potassium {Potassii Carbonas, U. S. and B. P.). 
This salt is never used in medicine, except to prepare other salts, as 
it is disagreeable to the taste and is an irritant. (See Potassium 
Citrate.) 

POTASSIUM CITRATE. 

Citrate of Potassium {Potassii Citras, U. S. and B. P.) is a white, 
granular, deliquescent salt, almost neutral in reaction and very solu- 
ble in water. It is by far the most agreeable of all the salts of potas- 
sium to the taste. In the early stages of bronchitis it is of the greatest 
value when combined with ipecac (see Bronchitis), and it is also use- 
ful as an alkaline diuretic. In bronchitis the dose should be 20 grains 
(1.4) every four hours, and in urinary incontinence due to acid and 
concentrated urine the dose should be equally large. 

Under the name of neutral mixture {Mistura Potassii Citratis), 
made by adding to 1 pint {^ litre) of lemon-juice enough bicarbonate 
of potassium to neutralize it, we have a useful febrifuge drink in 
fevers, particularly those of childhood. The dose is \ to 1 ounce 
(15.0-30.0) every few hours. 

Liquor Potassii Citratis, U. S., is made in the same manner as is 
tbe neutral mixture, except that citric acid is substituted for the 
lemon-juice (citric acid 6 grm., potassium bicarbonate 8 grm., and 
water 100 cc). 

The neutral mixture is the better preparation of the two, but more 
expensive. A very refreshing and agreeable way of prescribing this 
drug is in the form of "effervescing draught," made by mixing two 
solutions which are prepared as follows: 1. Lemon-juice and water, 
equal parts, enough to make 4 ounces (120 cc.). 2. Bicarbonate of 
potassium 1 drachm (4.0) and water 3 ounces (90.0). These solutions 
are to be mixed in the quantities desired, and taken while effervescing. 
If lemon-juice is not at hand, a solution of citric acid of the strength 



POTASSIUM IODIDE— PYOKTANIN. 373 

of 2 drachms (8.0) to 4 ounces (120.0) of water should be employed 
in its stead. 

Under the name of Potassii Citras Effervescens the U. S. P. of 
1890 calls for an official powder possessing the advantages of the 
mixture just named. 

POTASSIUM IODIDE. 

(See Iodide of Potassium.) 

PROTARGOL. 

Protargol is a new silver preparation containing 8.3 per cent, of 
silver, and occurs as a yellowish powder readily dissolved in cold and 
hot water, forming a clear solution. It is employed in gonorrhoea and 
in gonorrhoea! conjunctivitis because it is destructive to the gonococcus. 
(See Conjunctivitis.) It is not precipitated on contact with albumin 
or alkalies, nor by dilute hydrochloric acid. It therefore has distinct 
advantages over nitrate of silver. A 1 to 5 per cent, solution of pro- 
targol is the strength ordinarily used in the treatment of gonorrhoea, 
and these solutions may also be employed in the eye. (See Conjuncti- 
vitis.) If used on a camel's-hair brush or swab, the solution may be as 
strong as 5 per cent. ; but if the drug is used as a colly rium its strength 
should not exceed 1 : 400 or 1 : 200. 

PRUNUS VIRGINIANA. 

Prunus Virginiana, TJ. S., and Pruni Virginians Cortex, B. P. — 
Wild Cherry, as it is incorrectly called — is the bark of Prunus sero- 
tina, a large tree of the United States and Canada. It contains a 
substance, known as amygdalin, which when it comes in contact with 
water forms hydrocyanic acid through the action of another substance, 
known as emulsin. 

Therapeutics. — Wild-cherry bark is largely used as a domestic 
tonic, and in the form of a syrup as a vehicle for cough mixtures. 

It has been supposed that the hydrocyanic acid present allays the 
cough, but this is doubtful, as the acid is very fleeting in its effect and 
is present in very small quantity. 

Administration. — As a tonic it is used in the form of the infusion 
(Infusum Pruni Virginians, TJ. S.), dose -J- to 1 ounce (15.0-31.0), 
and the fluid extract (Pxtr actum Pruni Virginians Fluidum, TJ. S.), 
dose 30 minims to 1 drachm (2.0-4.0). The syrup (Syrupus Pruni 
Virginians, TJ. S. and B. P.) is given in the dose of 1 to 4 drachms 
(4.0-16.0). The B. P. also contains a tincture (Tincturs Pruni 
Virginians), given in the dose of 1 to 2 drachms (4.0-8.0). 



PYOKTANIN. 
(See Methyl Blue.) 



374 BBUGS. 

PYROGALLOL. 

Pyrogallol, U. S., sometimes called Pyrogallic Acid, is a triatomic 
phenol obtained by dry distillation of gallic acid, and should be kept 
in dark, ay ell-stoppered bottles. It occurs in light white scales or 
crystals, has no odor, but a bitter taste. If exposed to the light, it 
becomes dark. It is soluble in 1\ parts of water, and readily so in 
ether and alcohol. 

Therapeutics. — Pyrogallol is used in parasitic skin diseases, in 
ointment, in the strength of 30 to 100 grains (2.0-7.0) to the ounce 
(30.0). The stronger ointments exercise a mild caustic effect. It 
may be employed in place of chrysarobin in psoriasis. Unfortu- 
nately, it stains the skin a deep brown. 



QUASSIA. 

Quassia, U. S. (Quassice Lignum, B. P.), is the wood of Picrcena 
excelsa, a large tree of Jamaica and other islands of the West Indian 
group. It contains an active principle, named quassin, which is 
intensely bitter and an irritant to mucous membranes. 

Quassia is a simple bitter tonic which has been used very largely in 
domestic medicine and by the medical profession. It is very efficient 
as a tonic, is supposed to be particularly useful in the anorexia follow- 
ing malarial fevers, and has even been thought to possess antiperiodic 
power. In simple dyspepsia with eructations after meals, due to gas- 
tric inactivity, it is very serviceable. 

In the treatment of seat-worms (Oxyuris vermicularis), or thread- 
worms^ as they are often called, injections of the infusion of quassia 
are the most efficacious and useful remedial measures we possess, and 
yet are harmless to the patient. The bowel should be well washed 
out with soap and water, and \ pint to 1 pint of an infusion, made 
by adding 1 or 2 ounces (30.0-60.0) of quassia chips to a pint (^ litre) 
of water, should be injected and retained for some minutes. A few 
such injections will invariably kill the parasites, provided the bowel 
is first well washed out with soap and water and enough fluid is 
injected to reach high up into the rectum. 

Administration. — The tincture (Tinctura Quassice, U. S. and B. P.) 
is given in the dose of ^ a drachm to 1 drachm (2.0-4.0), the fluid 
extract (Extractum Quassia 3 . Fluidum, U. S.) \ a drachm (2.0), and 
the solid extract (Extractum Quassia?, U. S.) 1 to 3 grains (0.05- 
0.2). The infusion (Infusum Quassia, B. P.) is given in the dose 
of I to 2 ounces (10. 0-04.0), and is made by macerating 1 drachm 
(4.0) of quassia with 10 ounces' (320.0) of water, and allowing it to 
stand twenty-four hours or more. 

Liquor Quassias Concentratus is official in the B. P. Its dose is 
1 drachm (4.0). 



QUERCUS ALBA—BESOBCIN. 375 

QUERCUS ALBA. 

Quercus Alba, TJ. S., or White Oak, in infusion is used as an 
astringent injection in gonorrhoea and vaginitis in the female, where 
a large amount of fluid is necessarily employed. It is also used in 
prolapse of the rectum, in hemorrhoids, in leucorrhoea, and as a gargle 
in sore throat. It stains the clothing very slightly. 

Quercus Tinctoria is equally efficient, but is seldom used, because 
it stains the clothes very badly. Either may be used in infusion of 
the strength of 1 ounce to the pint (32.0 : J litre). In the form of 
the powdered bark it is often used as an astringent poultice to freely 
running sores to check the discharge. 

RESIN, or ROSIN. 

Besina, TJ. S. and B. P., is Resin or Rosin, the mass left after 
the distillation of turpentine, and enters largely into plasters, cerates, 
and similar preparations. Its burning fumes when inhaled are said 
to be of value in cases of chronic bronchitis. Ceratum Besina?, TJ. 8., 
is used in chilblains and superficial scalds, and Emplastrum Besince, 
TJ. S. and B. P., is adhesive plaster. Unguentum Besince is a B. P. 
preparation used for the same purposes as the plaster or cerate. 

RESORCIN. 

Besorcin, TJ. S. (metadioxybenzol), is the meta-comipound of the 
group of which hydrochinone is the para- and pyrocatechin the ortho-, 
and occurs in clear crystals of a slightly reddish hue. It is quite 
soluble in water, alcohol, and ether. 

Physiological Action. — Resorcin is an irritant to mucous mem- 
branes, and when taken internally in poisonous doses causes deafness, 
giddiness, salivation, profuse sweat, unconsciousness, and clonic con- 
vulsions. The heart of the dog under its influence is at first slowed 
by vagal stimulation, and then becomes very rapid from vagal palsy. 

Therapeutics. — Resorcin has been found of service as a remedy for 
whooping cough, given in the dose of 10 minims (0.65) of a 2 per cent, 
solution or used in a spray of the same strength, the latter being the 
better method of using the drug. 

Resorcin has also been employed in a spray in 2 per cent, solution 
in hag fever with remarkably good effects. It has been used as an 
antipyretic, but is not serviceable and has little power over strong 
fevers. 

The chief use of resorcin is in skin affections of a subacute or 
chronic character, such as eczema with much induration, and in psori- 
asis. In these states an ointment of the following character, well 
applied, is of service : 

R. — Kesorcin £j (4.0). 

Zincioxidi gj (4.0). 

Ung. aquae rosse . . . , £x (40.0). — M. 

S. — Apply to the part affected twice a day. 
After mixing the ointment heat it until the resorcin crystals melt, to prevent any 
irritation of the skin. 



376 DRUGS. 

Resorcin is also of service in weak solution in allaying itching of 
the skin due to erythematous eczema. For this purpose it should be 
used in watery solutions of about 10 to 15 grains to the ounce, and a 
little salt added to aid in its absorption by the skin. This should be 
dabbed, not rubbed, on the part : 

R. — Kesorcin gr. xv (1.0). 

Glycerin rt^x (0.65). 

Liquor calcis ffi (30.0).— M. 

In slowly spreading epithelioma of the face the following plaster, 
recommended by Hartzell, is useful : 

R— Resorcin gr. lxxii (5.0). 

Cerae flav. et pulv. resinae 3jss. (6.0) 

01. olivse . . q. s. — M. 

Within the last few years resorcin has been employed with good 
results in the treatment of gastric ulcer in the dose of 2 to 4 grains 
(0.1-0.2) before each meal in pill or capsule. It is supposed to act 
by reason of its analgesic, antiseptic, and haemostatic power. 

RHIGOLENE. 

This is a product of petroleum obtained by repeated redistillation 
until the liquid resulting from this process boils at 64.4° F. It 
evaporates more rapidly than any other known liquid, except cymo- 
gene, which boils at 32° F., and is used in a spray for the production 
of localized numbness or freezing before minor painful operations, 
such as the use of the actual cautery. 

RHUBARB. 

Rheum, U. S. (Rhei Radix, B. P.), is the root of Rheum offici- 
nale, a plant of Thibet, but which is cultivated in America and else- 
where. It is also derived from China, and this variety is known as 
Chinese rhubarb. Several alkaloids are contained in it, all of which 
are unimportant and never used alone, except chrysophanic acid. 

Physiological Action. — According to the studies of Prevost and 
Binet, rhubarb acts inconstantly upon the flow of bile, sometimes 
increasing it, sometimes having no effect, but, on the other hand, 
according to those of Rutherford and Vignal, it never fails to stimu- 
late biliary secretion. Owing to the astringent properties possessed 
by rhubarb, it does not purge excessively, and improves the appetite, 
digestion, and intestinal tone. Its constant use produces chronic 
constipation. 

Therapeutics. — Whenever it is desired simply to unload the bowels 
without affecting the general system rhubarb may be employed. In 
children a state is very commonly seen in which constipation is re- 
placed by diarrhoea if any ordinary laxative is employed, and in 
these instances rhubarb is the best remedy, as it is astringent and 
prevents any after-effects other than those directly produced by the 
dose. In the summer diarrhoea of children, when the stools are green, 



RHUS AROMATIC A— RHUS GLABRA. 377 

rhubarb is often used to empty the bowels of fermentative products 
before direct treatment is instituted. 

Rhubarb, because of its chrysophan, may stain alkaline urine car- 
mine or acid urine yellow. 

Administration. — The preparations of rhubarb are unnecessarily 
numerous. Rhubarb itself may be given in the dose of 20 grains 
(1.3) in powder, and small pieces of the root are habitually chewed 
by some persons for the relief of constipation. Extractum Rhei, 
U. S. and B. P., is given in the dose of 5 to 10 grains (0.32-0.65) 
in pills. Pilulce Rhei, U. S., of which each pill contains 3 grains 
(0.25) of rhubarb, is given in the dose of one to three pills (0.05-0.25) ; 
and Pilulce Rhei Compositus, U. S., and Composita, B. P., which 
contain 2 grains (0.1) of rhubarb and 1J (0.09) of aloes, are given in 
the same dose. Pulvis Rhei Compositus, U. S. and B. P., contains 
rhubarb, magnesia, and ginger, and is given in the dose of 20 to 40 
grains (1.3-2.6); Extractum Rhei Fluidum, U. S., is given in the 
dose of 20 to 30 minims (1.3-2.0). Syrupus Rhei, U. S. and B. P., 
is given in the dose of 1 drachm (4.0) to a babe, and 4 drachms (16.0) 
to an adult, although rarely used for older persons. Syrupus Rhei 
Aromaticus, U. S., is given in the same dose and to the same class of 
cases. Tinctura Rhei, U. S., is used in the dose of 1 to 2 drachms 
(4.0-8.0), Tinctura Rhei Aromatica, U. S. 9 Tinctura Rhei Composita, 
B. P., is used in the dose of J to 1 drachm (2.0-4.0), and Tinctura 
Rhei Bulcis, U. S., 2 to 3 drachms (8.0-12.0). The aromatic syrup 
is commonly employed for children, and the compound pills for adults. 
Infusum Rhei, B. P., is given in the dose of 1 to 2 ounces (30.0-60.0), 
and Mistura Rhei et Sodce, U. S., in the dose of 2 drachms to 3 
ounces (8.0-96.0). 

Liquor Rhei Ooncentratus is official in the B. P. Its dose is 1 
drachm (4.0). 

RHUS AROMATICA. 

Sweet Sumac is unofficial, but has been so largely used of late 
that it deserves notice. In hcematuria, menorrhagia, diabetes insip- 
idus, and in urinary incontinence in children depending upon vesical 
atony it has been highly praised. In the latter affection a sufficient 
amount of experience has been acquired to show that it really is of 
benefit. Rhus aromatica should be used in the form of the fluid 
extract, derived from the bark of the roots according to the general 
directions in the Pharmacopoeia for making fluid extracts. The 
dose as a remedy for urinary incontinence is 15 minims (1.0) of this 
preparation. Adults may take from 15 to 60 minims (1.0-4.0). The 
drug is best given with glycerin and water. 

RHUS GLABRA. 

Rhus Grlabra, U. S., Smooth Sumac, is the fruit of Rhus glabra, 
and contains tannic and malic acids as its chief constituents of 
medicinal value. In the fluid extract (Extractum Rhois Grlabrce 



378 DRUGS. 

Fluidum, U. S.) we have an official preparation which is very 
efficient as a gargle for sore throat when diluted with glycerin and 
water or prepared according to the formula given under Chlorate 
of Potassium. 

ROCHELLB SALT. 

Potassii et Sodii Tartras, U. S. {Soda Tartarata, B. P.), is largely 
used as a saline cathartic in the dose of \ an ounce (15.0), and is 
preferred by many patients to Epsom salts because its taste is not so 
disagreeable. It is, however, more irritating. Rochelle salt is the 
purgative constituent of Seidlitz powder. 

ROSA CENTIFOLIA. 

Rosa Centifolia, U. S., Pale Rose, possesses almost no medicinal 
value, but is mentioned because its official preparations are largely 
used by the laity and physicians. 

Aqua Rosa?, U. S. and B. P., is used as a diluent or solvent for 
preparations, such as astringents, which are to be employed locallv, 
as in injections for gonorrhoea. It may also be used internally for 
these purposes. Unguentum Aquos Rosas, U. S. and B. P., is " cold 
cream," and is largely used as an emollient application to small burns, 
sores, cuts, scratches, and chapped hands and lips. It is much 
improved if a little glycerin and benzoic acid are added to keep it 
sweet in warm weather. 

ROSA GALLICA. 

Rosa G-allica, U. S. (Rosas Gfallicas Petala, B. P.), Red Rose, con- 
tains more gallic and tannic acids than pale rose, and is astringent. 
From it are prepared the Extr actum Rosa? Fluidum, U. S., dose 5 
drops to 2 drachms (0.35-8.0), used to flavor other extracts, and the 
Confectio Rosa 3 , U. S., and Confectio Rosas Grallicas, B. P., which 
are used as bases for pills. Mel Rosas, U. S., or honey of rose, is 
employed as a local application or as a vehicle for gargles, and the 
Syrupus Rosas, U. S. and B. P., dose 1 to 2 drachms (4.0-8.0), as a 
flavoring substance. The acid infusion (Infusum Rosas Acidum, 
B. P.) is given in the dose of 1 to 2 ounces (30.0-60.0). 



RUBUS ID^EUS, or RASPBERRY. 

Rubus Idosus, U. S., or Raspberry, is used for the preparation of a 
syrup (Syrupus Rubi Idasi, U. S.) which is employed very largely as 
an elegant vehicle or flavoring mixture. The leaves are often used 
in domestic medicine in a decoction or infusion for the cure of diar- 
rhoea when an astringent is needed. 



B TJE—SALICIN. 379 



RUE. 



Ruta graveolens is the source from which we derive the Oil of Rue. 

Physiological Action. — Locally applied, rue is an irritant, produ- 
cing vesication, and if taken internally in large amount gastro-enteritis, 
which may be very severe. It is eliminated by the lungs, kidneys, 
and skin, and its odor is easily noticed in all these secretions. If the 
dose be poisonous, vomiting, great pain in the belly, and epileptiform 
convulsions come on, but death has rarely occurred. 

Therapeutics. — Rue has been used as an abortifacient, but with 
great danger to the mother. Its action is most uncertain even when 
poisonous doses are employed. It has been given in colic as a car- 
minative, and seems to be really valuable in atonic menorrhagia and 
metrorrhagia. 

Oil of rue has been employed for the removal of lumbricoid or 
round-worms, but ought not to be so used. The dose of the oil is 3 
to 6 minims (0.25-0.40), best given in capsule. 



SACCHARIN. 

Saccharin (Grlusidum, B. P.) is a compound first prepared by 
Fahlberg under the direction of Professor Remsen, of Johns Hopkins 
University. It is a remarkably sweet substance, two hundred and 
twenty times stronger than sugar in sweetening power, and is used 
largely to sweeten glucose and in confections. It escapes from the body 
unchanged, and is used in place of sugar to sweeten coffee, food, or 
medicine in cases of diabetes and gout. 

The dose is indefinite, but it is to be noted that a very few grains 
will sweeten a very large bulk of material. As 1 grain (0.06) is 
equivalent to about 1 teaspoonful (16.0) of sugar, less than 1 grain is 
the quantity usually given. It is commonly sold in small tablets con- 
taining half a grain each (0.03). 

Physiological Action. — Upon the circulation and similar vital func- 
tions saccharin has no effect, but Plugge has proved it to retard the 
action of all the digestive ferments, and to be in consequence harmful 
to diabetics whose digestion is impaired. 



SALICIN. 

Salicin (Salicinum, U. S. and B. P.) is a neutral principle ob- 
tained from several species of Salix and Populus. In other words, 
it is obtained from willow-bark. It is crystalline, without odor, and 
quite bitter, and is soluble in 28 parts of water and 30 of alcohol. 
Salicin is highly thought of by many practitioners as a substitute for 
salicylic acid in the treatment of acute articular and muscular rheuma- 
tism. It has also been largely used in the treatment of influenza. 
The dose is from 10 to 40 grains (0.65-2.6) every four hours, and it is 
best given in capsule or cachet, and washed down with a draught of 
water or milk after food has been taken. 



380 DRUGS. 

SALICYLIC ACID. 

Salicylic Acid (Acidum Salicylicum, U. S. and B. P.) occurs in 
fine white crystals or in fine white powder. It has a sweet yet acrid 
taste, and is derived from carbolic acid by treating it with caustic 
soda and carbonic acid at a moderate heat. Sometimes it is derived 
from plants in which it exists in combination, although the artificial 
acid is chiefly used. If the crystals are pinkish in hue, the acid 
should not be used, as it is probably impure. It is soluble in 500 
parts of water and 4 parts of alcohol. 

Physiological Action. — On mucous membranes salicylic acid acts 
as an irritant. (See Poisoning.) 

Nervous System. — Upon the nervous system salicylic acid exerts 
comparatively slight effects in medicinal doses, but causes buzzing in 
the ears, decrease of the reflexes, and in poisonous doses epileptiform 
convulsions by an action on the brain. 

Circulation. — Upon the circulation the effects of salicylic acid 
are not very marked in medicinal dose. It undoubtedly has a depress- 
ant rather than a stimulant effect, but the depression is very slight. 
It is sufficient, however, to make the use of the drug in cases of feeble 
circulation worthy of thought and care. 

Respiration. — Salicylic acid feebly stimulates the pulmonary 
vagi and respiratory centre, but if the dose be poisonous death is due 
to respiratory failure. Medicinally it does not effect this function. 

Temperature. — The effect of salicylic acid on temperature has 
been studied by the author with a good deal of care. The drug acts 
as a distinct antipyretic upon fevered states, and is a slight depress- 
ant of normal bodily heat. The studies of Gedl, Furbringer, and 
Se'e also show this, and those of Danewsky point to it. In the experi- 
ments of North upon man, after and during exercise, the antipyretic 
effects were marked. According to the author's studies, the drug 
lowers fever by diminishing heat-production and increasing heat-dis- 
sipation, but this is by no means positively decided as a fact. 

Aesorption and Elimination. — Salicylic acid is absorbed from 
the stomach as a salicylate of sodium, and so circulates in the blood. 
It is eliminated by the kidneys and by all the secretions. In the 
urine it appears as salicyluric acid. According to Kolbe, after a dose 
of 1 ounce (31.0) elimination does not commence for three hours, but 
Fleischer found the drug in the urine in one and a half hours. Usually, 
however, it is far more rapidly eliminated, and, as pointed out by 
Soullier, after a dose of 15 grains (1.0) it appears in the urine in ten 
to twenty minutes and after 30 grains (2.0) in five minutes. The 
elimination continues for a period of from thirty-three to fifty-six hours. 
( Weill). The urine after very large doses is dark olive-green, and this 
change in color is due to the presence of indican and pyrocatechin. 
which are formed by the action of the pancreatic juices upon the drug 
in the intestine. The presence of salicyluric acid in the urine is to 
be discovered by the addition of a solution of the chloride of iron to 
that fluid, which causes the appearance of a violet color. 

Poisoning. — Salicylic acid when taken in excessive dose causes 



SALICYLIC ACID. 381 

profuse sweating, roaring in the ears, dimness of vision, headache, 
partial or total deafness, and a decided fall in temperature. The 
pulse becomes weak and relaxed, and finally ptosis, strabismus, and 
general paralysis ensue. The urine and faeces are passed involun- 
tarily, and the urine is olive-green in color. The respirations at first 
are quickened and deepened, but finally become shallow and feeble, 
death ensuing from respiratory failure. 

If the dose is sufficiently large, the blood is involved and the cor- 
puscles rapidly break down. 

Therapeutics. — Salicylic acid, owing to its close resemblance to 
quinine, was first introduced as an antiperiodic and antipyretic, but 
soon was found to be of an inferior value in these states and of super- 
lative value in rheumatism. 'At present it is rarely if ever used for 
either of the former purposes, but is largely employed as a standard 
remedy for the latter disease. (See Rheumatism.) 

The value of salicylic acid in rheumatism limits itself solely to 
the relief of pain and the cure of the malady without preventing the 
complications incident to its course. That is to say, the changes in 
the joints or heart in rheumatism are only of less frequency after the 
use of salicylic acid because the drug shortens the disease, and not 
because it prevents these changes by a direct influence ; this is also 
true of rheumatic hyperpyrexia, where salicylic acid is of service 
in shortening the attack, though it often fails to control the tempera- 
ture to any great extent. In acute rheumatism 15 to 20 grains (1.0- 
1.3) should be given every four hours until marked physiological 
symptoms occur. Another method is to give 30 or 40 grains at 7 and 
9 P. M., with a copious draught of milk, so that the main effects will be 
produced during sleep. It is to be remembered, however, that in many 
cases the salicylates are of no value whatever, merely producing sweats 
and headaches, and it is also worthy of note that nothing else does 
these cases much good, as they seem bound to run a given course before 
the patient recovers. If a cure does take place, relapses are very 
common indeed, and the drug should always be continued for many 
days after all symptoms cease. In gonorrhoea!, rheumatism salicylic 
acid is of little value, for it has no influence upon the gonococcus in 
the joints. In rheumatoid arthritis it is valueless. The question 
as to the value of the salicylates in cases of gout is one open for debate. 
Some physicians regard it as useful, others as useless. Thus Duckworth 
states that in his experience and that of his friends the salicylates do 
not compare with colchicum. On the other hand, See, Jaccoud, and 
Haig find them useful. If they are of any value, it is only when the 
dose is very large, and even then their usefulness seems to be doubtful. 
In subacute rheumatism citrate or acetate of potassium may be used 
in place of salicylic acid in the dose of 30 to 60 grains (2.0-4.0), 
and these salts are to be taken just before going to bed. In 
lumbago, sciatica, and similar states salicylic acid is a very useful 
remedy. While .it is not as good as antipyrin in neuralgia, it is 
of great service in the migraine of rheumatic persons, often entirely 
curing the disease. Haig has proved that the salicylic compounds 



382 DRUGS. 

all aid in the excretion of uric acid, and thinks they relieve rheuma- 
tism in this manner. 

Brunton has highly recommended the use of the salicylates with 
the bromides in the nervous irritability of gouty or lithaemic persons. 

Salicylic acid has been largely used for the removal of pleural effu- 
sion if the effusion be serous. Dock believes that the duration of 
treatment is less with the salicylates than by the use of diuretics, 
alteratives, or purgatives, but the author has not reached good results 
from this plan of treatment. The dose should be from 1 to 2 drachms 
(-4.0-8.0) daily. Doses larger than this are not necessary. How sali- 
cylic acid does good in pleural effusion we do not know, for its diuretic 
properties are not sufficiently great to drain away the liquid by this 
means. 

In quinsy or true tonsillitis the drug is a specific, particularly when 
rheumatism is the cause. It will generally prevent suppuration, shorten 
the attack, and relieve the pain and swelling. The doses should be 
small, say 3 grains (0.25) at each dose, and given hourly. In stomatitis, 
after the blisters have broken, the burning and pain are often intense, 
and a mouth-wash of salicylic acid in the proportion of 1 to 250 of 
water is useful. 

Ringer recommends the use of the following salve in pruritus of 
the anus and vulva : 

R— Acid, salicylic • . . gij (8.0). 

01. theobroma- ^v (20.0). 

Cetaceae ^iij (12.0). 

01. myristicse f3iss (6.0).— M. 

In the treatment of corns there is probably no better application 
than lint soaked in a solution of salicylic acid, or the use of the fol- 
lowing formula : 

R. — Acid, salicylic gr. xxx (2.0). 

Ext. cannab. indicse gr. v. (0.35). 

Collodii f^ss (15.0).— M. 

S. — Apply with a brush until a good coat is formed. 

A useful salve for the soreness following horseback or bicycle 
riding is one composed as follows : 

R. — Acid, salicyl gr. x. (0.65). 

Adip. benzoinat ^j (32.0). — M. 

S. — Apply to the sore part. 

A solution of salicylate of sodium or of bicarbonate of sodium, 
applied on lint to inflamed rheumatic joints, often gives great relief. 
Smearing an ointment of salicylic acid over the joints not only pro- 
duces good effects locally, but by absorption of the drug influences 
the disease. (See Rheumatism, Part IV.) 

In gastric dilatation or catarrh, where vomiting occurs and the 
matters vomited contain sarcince, salicylic acid will be found of ser- 
vice, as it acts as an antiseptic in the stomach. In adults suffering 
from ascaris lumbricoides, or round-warms, salicylic acid may b< used 
in the dose of 8 grains (0.6) every hour till 40 grains (2.05) are 
t;ik<n. This treatment should be followed by the use of a purge. 



SALICYLIC ACID. 383 

For thread- or seat-worms the following injection will be found of 
service : 

R —Acid, salicylic . ^ss (2.0). 

Sodii borat. ,^ss (2.0). 

Aquffi . . . . Oj (500.0).— M. _ 

S. — Warm, and inject into the bowels. For a child reduce this one-half in all its 
parts. 

In bromidrosis of the feet (excessive sweating with foetor) salicylic 
acid may be dusted over the parts, or the following powder used : 

B -p";f C -} • • • • •-••••-Sss(16.0).-M. 

S. — Apply to the feet. 

In eczema of the face and hands, where the eczema is of the wet or 
weeping variety, salicylic acid, locally applied, is often of great service. 

R. — Acidi salicylic gr. v vel x (0.3-0.65). 

Pulv. amyli gij (8.0). 

Pnlv. zinci oxid ^ij (8.0). 

Petrolati '|ss (16.0).— M. 

S. — Apply locally. 

If the eczematous process is subacute and needs stimulation, the 
salicylic acid may be increased to 20 or 30 grains (1.3-2.0). 

Contraindications to the use of the salicylates are meningeal in- 
flammation or congestion, middle-ear disease, albuminuria, inactivity 
of the kidneys, particularly that occurring in pregnancy and in 
Bright's disease. 

Antiseptic Use. — Salicylic acid is employed as an antiseptic in the 
treatment of ivounds as a local remedy and as a dressing, but should 
not be applied over too large an area, as it may be absorbed and pro- 
duce constitutional symptoms. As an application to small burns a 
mixture of 1 drachm (4.0) of salicylic acid to 8 ounces (256.0) of 
olive oil is of service. 

In the treatment of soft chancres and venereal sores salicylic acid 
has been largely used by some practitioners either as a salve or as a 
dusting-powder, as follows : 

R. — Acid, salicylic gr. xx (1.3). 

Alcohol gtt. xlv (3.0). 

Adipis benzoinat ^ij (62.0). — M. 

R. — Acid, salicylic gr. xy (1.0). 

Pulv. amyli vel cretse £ij (8.0). — M. 

Salicylic acid may be added to urine to prevent its decomposition, 
but will sometimes cause the tests for sugar to appear. Patients taking 
salicylic acid often notice that the urine is odorless after standing, and 
that it will remain fresh for many days because of the salicyluric acid 
present in it. It may cause, when taken internally, the reaction of 
sugar in the urine with Trommer's test. 

Untoward Effects. — Salicylic acid, as already stated, may produce 
headache and roaring sounds in the ears. In persons with middle-ear 



384 DRUGS. 

disease it is contraindicated unless urgently called for, as it often makes 
the deafness permanently worse. Sometimes erythema or acne follows 
its employment, and blindness and retinal hemorrhages have been 
found to occur. Striimpell asserts that delirium of an active character 
sometimes appears after full doses of salicylic acid, which delirium is 
usually happy in its type, and is seen most commonly in young girls. 
Sometimes full doses produce visions which may be seen only when 
the eyelids are closed. It would be impossible to enumerate all the 
untoward effects which have been noted, but it is worthy of remark 
that very few deaths have taken place. 1 Binz thinks that full doses 
of salicylic acid may produce abortion in women who already have a 
tendency to abort, and Yineberg thinks that menorrhagia and metror- 
rhagia are caused by it. 

Administration. — Salicylic acid has a nauseous, disagreeable taste 
and is irritant to the stomach. It may be given in a solution of 
glycerin and water, or its taste may be covered by the use of syrup 
of bitter orange-peel or syrup of ginger. The following formulae 
may be used : 

K.— Acid, salicylic ^ij (8.0). 

Tinct. lavandulse comp f 31V (15.0). 

Glycerini f.^ss (15.0). 

Aqua- destillat q. s. ad f ,|viij (240,0). — M. 

S. — A tablespoonful ( 15.0; every two hours. 

Or. 

R.— Acid, salicylic ^ij (8.0). 

Glvcerini f^ss (15.0). 

Syrup, aurantii f Jiv (120.0). 

Aquae destillat q. s. ad f^viij (240.0).— M. 

S. — A tablespoonful (16.0) every two hours. 

Salicylic acid may be used in pill or capsule, but as it is irritant 
to the stomach in so concentrated a form, it must be taken with some 
water or milk, and should follow rather than precede meals. 

If buzzing in the ears produced by this acid is annoying, bromide 
of sodium in the dose of 20 grains (1.3) will generally give relief. 

Salicylic-acid ointment (Unguentum Acidi Salicylici, B. P.) is a 
useful preparation for external application in chronic, deep-seated skin 
diseases. 

Salicylate of Methyl. 
(See Gaultheria.) 

Salicylate of Sodium. 

Salicylate of Sodium {Sodii Salicylas, U. S. and B. P.) is a less 
irritant and somewhat less disagreeable preparation than salicylic 
acid. Its interna] action, use, and doses are the same as those of the 
acid. It maybe given by dissolving it in milk, and then adding ren- 
net t<> produce ;i curd, which covers the taste and protects the .stomach. 

' See author's Boylflton Prize Essay of Harvard l/niversity on Antipyretics. 



SALOL. 385 

Other salicylates are largely used by some persons. Salicylate 
of lithium is supposed by some physicians to be of more value than 
the other salts. (See Aspirin and Salophen.) 

SALOL. 

In appearance, Salol, XT. S. and B. P., is a white crystalline 
powder, faintly aromatic and almost without taste. It is not soluble 
in water, but is in alcohol, and an alcoholic solution forms an imper- 
fect emulsion when mixed with water. Salol is also slightly soluble 
in copaiba, in the oils of sandalwood and of turpentine, and in 
mineral oils. This solubility is very useful in prescribing it with 
these remedies in certain diseases of the genito-urinary apparatus. 
(See Gonorrhoea.) 

Salol is a compound of 60 parts of salicylic acid and 40 of carbolic 
acid, and is decomposed by the pancreatic juice into these two sub- 
stances. For this reason overdoses are capable of producing symp- 
toms of carbolic acid poisoning. Thus 20 grains of salol (1.3) taken 
five times a day will cause a man to take 40 grains (2.65) of carbolic 
acid, which is almost a poisonous dose. 

Hesselbach has proved that large doses of salol are very apt to 
affect the kidneys unfavorably, and rightly believes it to be contra- 
indicated in all cases of renal inflammation of an acute type. 

It is worthy of note that the drug rarely produces untoward effects, 
although at one time a number of observers accused it of frequently 
doing so. 

Salol is used for the same purposes as salicylic acid in the treat- 
ment of rheumatism when the stomach is so irritated that it cannot 
bear the latter drug, as salol is dissolved in the small intestine. A dose 
often used is 5 grains (0.36) an hour, but this is too much, as a rule, 
and may produce renal irritation. Salol is also useful in muscular 
rheumatism and neuralgia due to exposure. In pharyngitis 5 grains 
(0.36) of salol, given three times daily, is a valuable part of the treat- 
ment of the affection, and in persons subject to chronic sore throat 
due to the uric acid diathesis this treatment will often produce extra- 
ordinary results. It is of the greatest use in duodenal catarrh and 
catarrhal jaundice to arrest intestinal fermentation. 

In the treatment of gonorrhoea in all its stages salol may be 
employed by the mouth, as in its elimination it sterilizes the urine 
and tends to disinfect or sterilize the urethra at each act of mic- 
turition. (See Gonorrhoea.) 

Salol is of very great value in cases of intestinal indigestion and 
fermentation, and is sometimes used in cases of mild or pernicious 
anosmia when it is thought that the development of decomposition pro- 
ducts is their cause. (See Anaemia.) In diarrhoea dependent upon 
such causes salol is one of the best remedies we have, since it renders 
the intestinal canal antiseptic, and so removes the cause of the disorder, 
instead of locking the putrid material in the bowel, as does opium. 
In cholera morbus the writer's friend, Dr. Fussell of Philadelphia, has 
found the following very useful : 

25 



386 DRUGS. 

R.-Salol 33 (4.0). 

Bismuth, subnitrat gij (8.0). 

Misturse cretse q. s. ad f^iij (90.0). — M. 

S. — Two teaspoonfuls (8.0) every two hours. 

Wide experience with the drug in the treatment of cholera during 
recent epidemics has proved it to be one of the best remedies we can 
employ in the treatment of this disease. 

Salol may be given in wafers, capsules, or pills, in the dose of 
5 grains (0.3) or more. 



SALOPHEN. 

Salophen has been introduced into medicine as a substitute for 
salol, and is said to possess the advantage of being far less poisonous 
than salol, because in this case the phenol of the salol is replaced 
by a compound of phenol which is innocuous. Experiments on ani- 
mals seem to indicate that these theoretical advantages are present in 
fact. Like salol, salophen is broken up in the intestine by the juices 
there present, and the result is salicylic acid and acetylparamidophenol. 
Salophen contains about 10 per cent, less salicylic acid than does salol 
(51 per cent.), and appears in the form of thin, white laminae nearly 
insoluble in water. It is tasteless. 

Therapeutics. — For the therapeutics of salophen the reader is 
referred to the article on Salol, as the indications for both drugs are 
identical, save that salophen can probably be used when salol cannot 
be employed. The dose of salophen is from 5 to 20 grains (0.32-1.3) 
three times a day. It can be very effectually combined with phen- 
acetin in the treatment of neuralgia. In subacute rheumatic affec- 
tions it is certainly very useful. 



SANDAL-WOOD OIL. 

Sandal-wood Oil {Oleum Santali, U. S. and B. P.) is derived from 
the wood of Santalum album, a tree of India, and has a hot, burning 
taste. The odor is very pleasant, and the oil has been used as a per- 
fume. In overdose the oil is capable of producing great irritation of 
the genito-urinary passages. 

Therapeutics. — The oil of sandal-wood is much used by genito- 
urinary surgeons in chronic gonorrhoea and gleet for the purpose of 
stimulating depraved mucous membranes to proper action, and in 
chronic cystitis to act as a tonic to the bladder. 

In the subacute or later stages of bronchitis, when the expectora- 
tion is thick and ropy and the cold is not readily "thrown off," the 
oil of sandal-wood is efficacious. Dr. Daggett strongly recommends 
its use in cases of asthma associated with marked catarrhal symptoms, 
and in the excessive cough following influenza it is of great value. 
In all cases it should be given in capsules in the dose of 5 to 20 
minims (0.35-1.3), 5 minims (0.35) being generally sufficient, although 



SANG UINAEIA— SANTONIN. 387 

druggists generally keep it in 10-minim (0.65) capsules. Oil of 
sandal-wood may irritate the stomach, but it is not so apt to do so as 
is cubebs or copaiba. 



SANGUINARIA. 

Sanguinaria, V. S., or Blood-root, is the rhizome of Sanguinaria 
canadensis, and has been largely used in medicine, but is a danger- 
ous remedy, possessing more power for harm than good. Its chief 
alkaloid is sanguinarine. 

Poisoning. — Sanguinarine in poisonous dose causes vomiting, purg- 
ing, profuse salivation, and finally tonic convulsions which are spinal 
in origin. Death is due to respiratory failure, but the circulation is 
much decreased in force and frequency. 

Therapeutics. — The employment of sanguinaria in chronic bron- 
chitis is about the only purpose for which it is now employed to any 
extent. As an emetic in croup it has been largely used, but is too 
irritating and depressing, and ought not to be so employed. According 
to Bartholow, the drug acts as an hepatic stimulant, and is of service 
in g astro-intestinal catarrh and jaundice. 

Administration. — The dose of the fluid extract (Extractum San- 
guinaria? Pluidum, U. S.) is 1 to 5 minims (0.05-0.35) as an expec- 
torant, or 10 to 30 minims (1.0-2.0) as an emetic. If the drug does 
not cause vomiting after an emetic dose, it must not be allowed to 
remain in the stomach, as it is poisonous. The tincture {Tinctura 
Sanguinaria? , U. S.) is the best preparation to use, and may be given 
in 20- to 30-minim (0.12-2.0) doses as an expectorant, and 1 to 3 
drachms (4.0-12.0) as an emetic. The vinegar {Acetum Sanguinaria?) 
is no longer official, but is given in the dose of 10 to 30 minims (0.65- 
2.0), and as an emetic in the dose of 2 to 4 drachms (8.15-15.0). 



SANTONIN. 

Santoninum, TJ. S. and B. P., is a neutral principle derived from 
Levant Worm-seed or Santonica, which is the unexpanded flower- 
heads of Artemisia paucijiora (Maritima, B. P.), a plant of Asia 
Minor and Turkestan. Santonin is soluble in alcohol and chloroform, 
but less so in water. Santonmic acid is formed by warming santonin 
with alkalies, and Hesse has found that santonin is an anhydride of 
santoninic acid. Santoninic acid is more soluble than santonin. 

Poisoning. — Santonin causes, when taken in overdose, muscular 
tremors, convulsive movements, unconsciousness, and sometimes epi- 
leptiform convulsions. 

One of the most common symptoms of the poisoning is chroma- 
topsia or xanthopsia, during the existence of which all objects look 
yellow. This is due to the staining of the humors of the eye by the 
drug. This may go on to total blindness or pass away in a few days. 
If the vision is not yellow, it may be green. The urine is also 
stained — first yellow, then saffron, and finally purple-red, or is 



388 DRUGS. 

bloody-looking. This is not due to the presence of blood, but to the 
drug. Poisonous doses of the drug do not cause gastro-enteritis. 

Therapeutics. — Santonin is used for the removal of the round-worm, 
and is very efficacious. It has no influence on the tape-worm. It 
should be given in the manner of all vermifuges (see Worms) — 
namely, at a time when the alimentary canal is empty. Santonin 
is said to have a distinct influence over vision, increasing, in me- 
dicinal amount, its acuity whenever the optic nerve is at fault. In 
urinary incontinence santonin will often produce a cure after all other 
remedies fail. 

Santoninate of sodium (Sodii Santoninas) is a useless, harmful 
preparation, never to be employed except for the benefit of the eye 
when vision fails through disease of the optic nerve. Introduced 
into medicine because of its solubility, it is absorbed into the system, 
which is just what is least desired in an anthelmintic, which should 
seek the worm in the bowel, not by entering the blood. In eye affec- 
tions the dose may be from 2 to 8 grains (0.1-0.6) a day, according 
to the age of the adult. 

Santonin may also be given in the dose of 1 to 2 grains (0.05-0.33) 
to an adult in capsules or wafers. The crystals should be used, not 
the powdered santonin. Within six hours after the drug is used, a 2- 
or 3-grain (0.1—0.15) dose of calomel is to be taken, and followed by 
a saline purge two hours later, as the flow of bile caused by the 
mercurial is particularly useful in making the worm let go its hold. 

Untoward Effects. — In addition to the curious effects already named 
santonin may cause urinary incontinence even in medicinal dose. 

Administration. — Santonin is best given in the form of a troche or 
lozenge {Trochisci Santonini, U. S. and B. P.), 1 grain (0.06) each, 
but it is to be distinctly borne in mind, and written on the prescrip- 
tion, that the Trochisci Sodii Santoninatis of the U. S. P. of 1880 
are not to be sold to the patient. The troches of santonin itself are 
now official in the U. S. P., but if the physician prefers to write for 
troches, they can be made as follows : 

R .—Santonini gr. v (0.3). 

Pulv. sacchari alb £iij (12.0). 

Pulv. acacia? gr. viij (0.5). 

Misce bene, et adde 

Acacise mucilag gtt. xvj (1.0). 

Aquae q. S. 

Ft. in troches No. x. 
S. — One or two lozenges, as directed. 



• 



SARSAPARILLA. 



Karsaparilla, U. S., is the root of Smilax officinalis, Smilax ornata, 
and oihcr species of Smilax. growing chiefly in Central America. It is 
known in the H. P. as Sarsce Radix. The drug is devoid of any marked 
physiological action, yet seems to possess some power over the general 
condition of the system. Thus while sarsaparilla seems utterly with- 
out effect in the hands of most physicians when given alone / it often 



SAVINE— SCAMMONY. 389 

seems to do good and to increase the effects of other drugs when com- 
bined with them, so that some cases of syphilis which are of an obsti- 
nate character will yield to iodide of potassium and sarsaparilla when 
the iodide alone fails. Sarsaparilla is largely used in domestic med- 
icine as a "blood-purifier," and is a prominent constituent of many 
patent medicines. It is useless for such purposes. 

Administration. — Sarsaparilla is most commonly given in the form 
of the compound syrup (Syrupus Sarsaparillce Compositum, XI. S.), 
composed of sarsaparilla, sassafras, liquorice, gaultheria, anise, and 
senna, dose 1 to 4 fluidrachms (4.0-15.0). (See Iodide of Potassium.) 
The other official preparations of the XI. S. P. are the compound decoc- 
tion (Becoctum Sarsaparillce Compositum), composed of the same 
principal ingredients as the compound syrup, except that anise, senna, 
and gaultheria are omitted, and mezereum and guaiacum wood are 
added, dose 4 to 6 fluidrachms (15.0-22.0) ; the compound fluid extract 
(Extr actum Sarsaparillce Fluiclum Compositum), similar to the syrup 
in composition, dose \ to 1 fluidrachm (2.0-4.0) ; and the fluid extract 
(Extr actum Sarsaparillce Fluidum), dose J to 1 fluidrachm (2.0-4.0). 
The B. P. preparation is a liquid extract {Extractum Sarsce Liquidum), 
dose | to 4 fluidrachms (2.0-16.0) .; and Liquor Sarsce Compositus 
Concentratus, dose 2 to 8 drachms (8.0-30.0). 



SAVINE. 

Sabina, XI. S. f is the tops of the Juniperus Sabina, an evergreen 
shrub of Northern Europe, Asia, and America. It contains an 
official volatile oil (Oleum Sabince, II. S.). Locally applied, it is 
more of a counter-irritant than is turpentine, and if swallowed in 
poisonous amount causes nausea, vomiting, gastro-enteritis, uncon- 
sciousness, suppression of urine, and death. If the individual be a 
pregnant female, abortion takes place as death approaches, but very 
rarely before this time. Profuse flooding nearly always accompanies 
the act. 

Therapeutics. — The oil, taken in the dose of 5 to 10 minims 
(0.35-0.65), repeated every three or four hours, acts as a powerful 
stimulant to the uterus and ovaries, causing hyperemia and aiding 
in the production of menstruation in cases of amenorrhcea. It may 
also be employed with advantage in some cases of menorrhagia. The 
drug is best given in emulsion or capsule. The fluid extract (Ex- 
tractum Sabince Fluidum, XI. S.) is given in the dose of 5 to 15 
minims (0.35-1.0.) 



SCAMMONY. 

Scammonium, XI. S., Scammonia? Radix, B. P., is a resinous exu- 
date from the root of Convolvulus Scammonia, growing in Asia Minor 
and Syria. Its active principle is sometimes called jalapin. 

Therapeutics. — Scammony is an irritant, drastic, hydragogue purge, 



390 DBUGS. 

which causes a good deal of griping and exerts a cholagogue effect. 
If an inflammatory condition of the bowels is present its use is contra- 
indicated. 

The ingestion of poisonous doses is to be followed by treatment 
suitable for gastro-enteritis. Scammony is given in the dose of 2 to 5 
grains (0.1-0.35), always in combination with some other similar 
drug — as, for example, colocynth. Scammony forms part of the com- 
pound extract of colocynth (Extr actum Colocynthidis Compositum, 
U. S. and B. P.), the dose of which is 1 to 3 grains (0.05-0.15) as a 
laxative or 5 to 20 grains (0.35-1.3) as a purge. The resin (Resina 
Scammonii, U. S. ; Scammoniai Resinoe, B. P.) is given in the dose 
of 3 to 8 grains (0.15-0.6). The B. P. preparations of scammony are 
Pilula Scammonii Composita, dose 5 grains (0.32) ; and Pulvis Scam- 
monii Compositus, dose 10 to 20 grains (0.65-1.3). The last two prep- 
arations are composed of scammony, ginger, and jalap. 



SCOPOLAMINE. 

Scopolamine is an alkaloid derived from Scopolamia atropoides, a 
plant of Southern Europe, which possesses medicinal powers closely 
resembling those of belladonna and its sister drugs. Its physiological 
action is very closely allied to that of hyoscine, one of the alkaloids 
of hyoscyamus, and, as stated in the article on Hyoscine, it is probable 
that much so-called hyoscine is scopolamine. 

Therapeutics. — Scopolamine is used in medicine chiefly by ophthal- 
mic surgeons, and in the eye is far less irritating than either of the 
alkaloids of hyoscyamus or atropine. Indeed, it may be considered as 
being distinctly sedative in plastic iritis. Its effects are not, however, 
so lasting as are those of atropine. The use of -gfa of a grain dropped 
into the eye in one dose produces a mydriasis in eighteen minutes and 
ciliary paralysis in twenty-three minutes. This mydriasis lasts about 
seventy-two hours, and the ciliary paralysis about ninety-six hours 
(Oliver). It finds its greatest usefulness in the early stages of iritis, 
when a rapidly-acting and efficient sedative mydriatic is demanded. 

Scopolamine is best used for this purpose in the strength of ^ of 
1 per cent. (1 : 500) in water. 

This solution may be dropped into the eye every twenty minutes 
till one hour has elapsed. As this use of the drug is slightly painful 
it is well to place a few drops of cocaine solution in the eye before each 
instillation of scopolamine. 

Internally scopolamine acts as a fairly powerful soporific in nervous 
insomnia, and in the sleeplessness of mania, and even when dropped 
into the eye its general systemic effect is soporific. 

Scopolamine itself is rarely employed, the hydrobromate of scopola- 
mine being preferable. It also occurs as the hydriodate and hydro- 
chlorate. 

The dose of these salts of scopolamine varies from yj-g- to ^ of a 
grain (0.0003-0.001) by the hypodermic needle or the mouth. 



SCOPARIUS AND SPARTEINE. 391 



SCOPARIUS AND SPARTEINE. 

Scoparius, TJ. S. (Scopari Cacumina, B. P.), or Broom, is the tops 
of the Oytisus Scoparius. It contains scoparin and sparteine, the 
first being a crystalline principle and the second a liquid alkaloid. 
The second (sparteine) is the alkaloid used in medicine in the form of 
a sulphate (Sparteines Sulphas, TJ. S.), which is a crystalline salt readily 
soluble in water. 

Physiological Action. — As scoparius depends for its medicinal value 
almost entirely upon sparteine, what is here said applies to both the 
crude drug and the alkaloid. 

Nervous System. — Sparteine acts on the nervous system very 
decidedly if given in large dose, depressing the brain and spinal cord, 
chiefly in its motor tracts, thereby causing a decrease of reflex action 
and motor power, ending in complete paralysis. These changes occur 
both in man and in the lower animals. 

Circulation. — Upon the circulation sparteine acts as a stimulant. 
It quickens the pulse-rate in moderate doses, and also raises arterial 
pressure. The force of the contraction of the ventricles is also increased. 
In very large poisonous doses the drug acts as a circulatory depressant. 

Respiration. — Upon this function in small amounts sparteine 
has no effect, but poisonous doses kill by paralysis of the respiratory 
centre. 

Poisoning. — The symptoms of poisoning consist in trembling and 
inco-ordination of movement, and clonic and tonic convulsions, fol- 
lowed by a second stage of depression of the nervous system and 
general enfeeblement. 

Therapeutics. — Sparteine has been recommended in all states of 
the heart in which digitalis is of service, and it is sometimes useful 
in those fairly frequent cases where digitalis fails. In cardiac arhyth- 
mia or palpitation it is thought to be of great service by those who 
have used it most. Clark found it of value in Gfraves's disease and 
in nearly every circulatory abnormality, but in the judgment of the 
author of this book sparteine is not a very useful drug — one only to 
be turned to as a last resource after more generally used remedies fail ; 
or, in other words, it is not a remedy to be employed as a" stand- 
by" in the manner in which digitalis is used. 

While some clinicians have found sparteine of value, many of them 
have not. In the few cases in which it has been used by the writer 
it entirely failed to be of service, perhaps because the cases were des- 
perate and the drug was tried after all the other remedies had failed. 
The dose is as variable as its action. Some state it to be -£$ of a grain 
(0.003), while still others recommend 2 to 4 grains (0.1-0.2). A small 
dose should be used at first, and rapidly increased until some effects 
ensue. To get the best effects it should be given every two hours in 
the dose of J of a grain. The drug should be given in watery solu- 
tion. 

Potts claims to have found sparteine of value in the treatment of 
tremor, as in paralysis agitans, in the dose of J to \ grain (0.015- 
0.025) three times a day. 



392 DRUGS. 

Scoparius itself is used in decoction, made by adding \ an ounce 
(16.0) of the broom-tops to a pint (-J litre) of water, and boiling them 
down to a ^ pint (250 cc). Of this, an ounce should be taken every 
three hours. This decoction is one of the most efficient diuretics in 
cardiac dropsy. An official fluid extract {Extractum Scoparii Fluidum, 
U. S.) is given in the dose of 30 minims (2.0). The official prepara- 
tions of the B. P. are an infusion {Infusum Scoparii), and the juice 
{Succus Scoparii), dose 1 to 2 drachms (4.0-8.0). 

SEIDLITZ POWDER. 

Under the official name of Pulvis Effervescens Compo situs the U. S. P. 
recognizes a purgative powder {Pulvis Sodas Tartar ato? Effervescens, B. 
P.) made by taking the bitartrate of sodium and potassium, or Rochelle 
salt, 120 grains, and bicarbonate of sodium 40 grains, which are 
wrapped in blue paper, and 35 grains of tartaric acid placed in a 
white paper. The contents of each paper are dissolved in a little 
water — half a tumblerful — and the two solutions added to one another 
and swallowed during effervescence. As much as two powders may 
be used, but this is generally too large an amount unless full purgation 
is needed. In sick stomach associated with constipation, when a whole 
powder cannot be retained, the two powders should be divided into 
fourths, and a fourth added to a fourth dissolved in a half-wineglass- 
ful of water and taken every fifteen minutes until the entire powder 
is ingested. This will often settle the stomach and produce purgation. 



SENEGA. 

Senega, U. S. {Senegas Radix, B. P.), is the root of Polygala 
Senega, a small plant of the United States, containing a principle 
known as polygalic acid and senegin. 

Therapeutics. — Senega is used in medicine as a stimulating expec- 
torant in the subacute and chronic forms of bronchitis. It has also 
been employed as a diuretic in cardiac dropsy or that due to renal 
disease. In cardiac disease it should not be used, and indeed it is 
rarely employed at present except in combination with other drugs 
in expectorant mixtures. 

Administration. — Senega is used in the form of the fluid extract 
(Extr -actum Senegas Fluidum, U. S.), dose 10 to 20 minims (0.65-1.3), 
and the syrup {Syrupus Senega?, U. S.), dose 1 to 2 drachms (4.0- 
8.0). It is also used in Coxe's Hive Syrup. The official preparations 
of the B. P. are — a tincture {Tinctura Senegcp), dose 1 to 2 drachms 
(4.0-8.0), and an infusion {Infusum Senegas), dose 1 to 2 ounces 
(30.0-00.0). 

SENNA. 

Senna, U. S.. is the most drastic of the laxative purges used for 
the relief of constipation. It is the leaflets of Cassia acutifolia and 



SENNA. 393 

Cassia angustifolia, and contains a very acrid irritant purgative princi- 
ple known as cathartic acid. Senna is official in the B. P. as Senna 
Indica and Alexandrina. 

Physiological Action. — Senna acts as a purge, producing copious 
stools, often with a great deal of griping if it is used alone. Accord- 
ing to Rutherford and Yignal, it acts very materially in increasing 
the flow of bile, but it is seldom, if ever, used in medicine as a chola- 
gogue, although, according to Prevost and Binet, cathartic acid has 
an influence over biliary secretion. Hess has found that the drug 
acts directly as a stimulant upon the mucous membranes, and so pro- 
duces a local peristalsis as it is moved along. It is also known that 
the drug is eliminated in the milk, and for this reason care should 
be taken in giving the drug to nursing mothers, as it will purge the 
nursling. 

Administration. — Senna is generally combined with other drugs 
for the relief of constipation, but may be used alone. If this is 
done, the fluid extract {JExtractum Sennas JFluidum, U. S.) may be 
employed in the dose of 1 to 2 drachms (4.0-8.0) to a child or 4 
drachms (15.0) to an adult. It is, however, always better to give 
children the more agreeable confection [Oonfectio Senna?, U. S. and 
B. P.) in the dose of J drachm (2.0) to a child or 1 to 2 drachms 
(4.0-8.0) to an adult. As the confection is apt to cause gastric dis- 
order if used continuously because of the sugar contained in it, its 
use is limited to a small class of cases. 

In the treatment of the constipation of pregnancy senna is thought 
to be very useful. In these cases and in others when cascara sagrada 
alone will not move the bowels, senna may be prescribed as follows : 

R— Ext. sennae fluid f^ij (60.0). 

Ext. cascarse sagradse fl fgj (30.0). — M. 

S. — Teaspoonful (4.0) at night, or night and morning. 

Should this produce griping \ to 1 minim (0.025-0.05) of fluid extract 
of belladonna may be added to each dose. Under the name of Black 
Draught a mixture of senna, manna, fennel, and sulphate of magnesium 
has been largely used {Infusum Sennas Compositum, U. S.) in the dose 
of 4 ounces (120.0). It is an active hydragogue purge. The syrup 
(Syrupus Sennas, U. S. and B. P.) is given in the dose of 1 to 4 
drachms (4.0-16.0). 

One of the best ways to use senna is in the compound liquorice 
powder (Pulvis Grlycyrrhizas Compositus, U. S. and B. P.), which is 
a good laxative in tlie dose of 20 to 30 grains (1.3-2.0). Compound 
liquorice powder is composed of senna, liquorice, oil of fennel, washed 
sulphur, and sugar. 

Infusum Sennas, B. P., is given in the dose of 1 to 2 ounces 
(32.0-64.0); Mistura Sennas Composita, B. P., in the dose of 1 to 2 
ounces (32.0-64.0), and Tinctura Sennas Composita, B. P., in the dose 
of 1 to 4 drachms (4.0-16.0). Liquor Sennas Concentratus, B. P., is 
given in the dose of 1 drachm (4.0). 

Senna, because of its chrysophan, may stain the urine carmine if 
that fluid is alkaline, or yellow if it is acid. No alarm should be felt 



394 DRUGS. 

if the color appears in this secretion. Often it is necessary to warn 
the parents of a child of the possibility of such an occurrence, in 
order to prevent any fright on the part of the mother, who otherwise 
might think that hematuria was present. 



SERPENTARIA. 

Serpentaria, U. S. (Serpentarice Mhizoma, B. P.), or Virginia 
Snakeroot, is the rhizome and rootlets of Aristolochia Serpentaria 
and Aristolochia reticulata, plants of the Southern United States. 
It contains an active principle, aristolochin, which is never used in 
medicine. 

Therapeutics. — Owing to the rather pleasant, warm taste of ser- 
pentaria, and the fact that it stimulates secretion, it is used largely as 
a vehicle for other more potent remedies. It has tonic properties, 
and in consequence has been largely used in the treatment of atonic 
dyspepsia and indigestion. It is even said to be a sexual stimulant, 
but this is doubtful, to say the least. In overdose it is an irritant, 
and will cause vomiting and purging if large amounts are taken. 

Administration. — Serpentaria is given in the form of the fluid 
extract (Extractum Serpentaria} Fluidum, U. S.) in the dose of 10 
to 40 minims (0.65-1.3), and the tincture (Tinctura Serpentaria?, U. S. 
and B. P.) in the dose of h to 2 drachms (2.0-8.0). It also enters 
into Huxham's Tincture of Cinchona (Tinctura Cinclionoe Composita, 
U. S. and B. P.). Infusum Serpentaria?, B. P., is given in the dose 
of 1 to 2 ounces (30.0-60.0). 

SILICATE OP POTASSIUM OR SODIUM. 

Soluble Glass, or Silicate of Potassium or Sodium, occurs as a 
clear syrupy fluid. It is used as a splint in the dressing of fractures 
and sprains, as it rapidly becomes hard and immovable when painted 
over the bandages. Silicate of potassium or sodium may be uni- 
versally substituted for plaster of Paris. The silicate of sodium is 
official as Liquor Sodii Silicatis, U. S. P. 



SOAP. 

Sapo, U. S. (Sapo Durus, B. P.), is prepared from any alkali and 
fixed oil, although soda and olive oil are most frequently employed 
in the manufacture of the soaps which are used medicinally. Castile 
soap, if good, is the best representative of a pure soap that we have. 

Son]) may be cut into the form of a suppository and used to pro- 
voke movements of the bowel in young children who are suffering 
from constipation by placing it just inside the anus, having previously 
dipped it into water one instant to make it slippery. It may also be 
used as an enema, dissolved in "warm water, or a mixture known in 
Philadelphia as the " House Mixture" may be employed in the case 



SODIO-SALICYLATE OF THEOBROMINE. 395 

of an adult. This consists of a mixture of water, soft-soap, and 
molasses in varying proportions, and if flatulence is present turpentine 
and olive oil are added to it. The preparation is as efficient as it is 
cheap and dirty. Soap is also used as an antidote to many poisons 
and as an aid to emetics. 

Green Soap (Sapo Mollis, IT. S. and B. P.) is not generally green, 
but brown. It is a soft soap made by the use of potash and olive oil, 
and is largely used by dermatologists in the treatment of eczema and 
similar skin diseases where a detergent, stimulating application is 
needed. It is sometimes called " German soft soap," to separate it 
from the ordinary soft soap, or the common sapo mollis, of this coun- 
try, which is an impure substance often made of rancid fats, contain- 
ing a large excess of alkali and never used except for scouring pur- 
poses. Green soap is not only employed as green soap, but in the 
liniment (Linimentum Saponis Mollis), which is to be thoroughly 
rubbed into the part when used medicinally, well Avashed off, and 
afterward simple cerate or some other soothing salve applied. 

Soap Liniment (Linimentum Saponis, IT. S. and B. P.), or Opo- 
deldoc, as it is called in domestic medicine, is largely used for rubbing 
stiff muscles and sprains. It is generally employed to carry more 
active external remedies, such as opium or aconite. 

R. — Tinct. aconiti "j 

Tinct. belladonnae V aa f%ij (8.0). 

Tinct. opii J 

Liniment, saponis q. s. ad ff vj (180.0). — M. 

Soap Plaster (JEmplastrum Saponis, IT. S. and B. P.) is used a: 
a thick, heavy protective for bed-sores or where bed-sores are feared 
It is also used as a support about sprained joints. 



SODIO-SALICYLATE OP THEOBROMINE. 

This compound, known as diuretin (or sodio-theobromine-salicy- 
late), derives its name from the extraordinary power which it is said to 
possess of producing a great increase in the urinary flow from the 
kidneys. This power depends entirely upon the theobromine, which 
is a crystallizable, bitter, and volatile alkaloid, closely allied to caf- 
feine and xanthine, and derived from the seeds oi Theobroma Cacao, or 
the source of ordinary chocolate. Owing to the insolubility of theo- 
bromine, it has been found necessary to combine it with sodium salicy- 
late, as under these conditions it is readily absorbed. 

The diuretic properties of this alkaloid were first discovered during 
a series of experiments made by Schroder in Strasburg in 1889, who 
found that the diuresis produced in man and the lower animals was 
very marked. A large number of clinical trials in Europe and 
America have confirmed his observations, but there are a number of 
cases in which it signally fails, particularly in chronic Bright's disease. 

Theobromine does not have so stimulating an effect on the heart as 
does its relative caffeine, so that the circulatory effect, while showing 



396 DRUGS. 

a stimulant rather than a depressing tendency, is very slight. It 
slightly increases muscular power, but its peculiar affinity for the 
renal structures surpasses all its other activities. 

As the action of the drug depends upon its ability to stimulate the 
secreting epithelium of the kidney, the physician should remember 
that in cases of advanced renal disease, where the secreting structures 
are almost entirely destroyed, no result can be expected from its 
administration ; but it is probable that the drug is useful in almost 
all conditions of dropsy, whether due to renal inactivity or cardiac 
disease, and is harmless to the patient even if the diuretic effect does 
not ensue. The only contraindication to the use of theobromine or 
diuretin is the presence of acute nephritis, when, of course, sedatives 
rather than stimulants are needed. So far as the writer is aware, no 
study as to the proportion of solids and liquids in the urine under the 
influence of this drug have been made, but the fact that it stimulates 
the epithelium or secreting structures of the kidney would indicate 
that the solids are increased. 

As diuretin only contains from 30 to 50 per cent, of theobromine, 
it has to be given in very large amounts, as much as 1 to 2 drachms 
(4.0-8.0) in twenty -four hours, preferably in divided doses of from 
10 to 20 grains (0.65-1.3) in capsule or in warm water. The former 
method is the better, as the taste of the drug is disagreeable and 
soapy. 

It must not be exposed to the air, as it undergoes decomposition. 

In all the cases in which the writer has tried sodio-salicylate of 
theobromine he has failed to see any effect produced, and, while he 
has no confidence in the drug, he mentions it because others claim 
to have obtained good results from its use. 



SODIUM. 

Sodium is a metallic element, the salts of which are usually white 
and colorless. It is not used in medicine, but many of its salts are 
employed. While potassium acts as a depressant to the body, sodium 
seems to exert comparatively little effect upon the animal economy. 
The salts vary in their power with the acid forming them. (See Ben- 
zoate of Sodium, Chloride of Sodium, Salicylate of Sodium, etc.) 

Acetate of Sodium (Sodii Acetas, U. S.) is rarely if ever used in 
medicine as a substitute for acetate of potassium. The dose is 20 to 
40 grains (1.3-2.65) three times a day. 



Sodium Bicarbonate. 

Bicarbonate of Sodium (Sodii Bicarbonas, U. S. and B. P.) is 
largely used as an antacid in gastric fermentation and in sick head- 
achea arising from this condition. Combined with calomel in powder, 
it certainly adds to its efficiency in increasing biliary flow, as all alka- 
lies of this class liquefy and thin the bile. The drug has been widely 



SODIUM. 397 

employed in the treatment of rheumatism, and is found to be of great 
service in allaying pain and soreness in the joints when used in a 
lotion made by dissolving it in water and applying it to the part on lint 
or rags. In acidity of the stomach the following effervescing powder is 
useful : Bicarbonate of sodium (Sodii Bicarbonas), 30 grains (2.0) in 
one paper, and in the other 5 grains (0.3) of tartaric acid (Acidum 
Tartaricum). These are each dissolved in half a tumbler of water, 
added to one another, and swallowed during effervescence. 

Sodium Cacodylate. 

Cacodylate of sodium is a white amorphous powder which is readily 
dissolved in water. Its uses in medicine are practically identical 
with those of arsenic (see Arsenic) ; it is said to be much better 
borne by the kidneys and stomach than any of the ordinary prepa- 
rations of arsenic. The drug is capable of being administered hypo- 
dermically without disagreeable local or general symptoms. It has 
seemed to do well in the debility and anmmia of tuberculosis. The 
dose is J to \ grain (0.02-0.03) subcutaneously, and 2 to 4 grains 
(0.12-0.25) by the mouth. Some of those who have used it most 
assert that its use by the stomach causes not only a strong, garlicky 
odor on the breath, but also gastric irritation. 

Gautier has advised the following formula for hypodermic use : 

R. — Sodii cacodylat gr. c (6 5). 

Aquas destillat fgiij (90.0). 

Acid, carbolici tt\J (0.06). 

This is to be boiled, filtered through a sterile filter, and 3 ounces 
(90.0) of distilled, sterile water added. The hypodermic dose of this 
is from 15 to 20 minims (1.0-1.3). 

Sodium Chloride. 

Chloride of Sodium (Sodii Qhloridum, U. S. and B. J\), or Com- 
mon Salt, is a useful drug and food, aiding in maintaining the alka- 
linity of the blood and tissues and in the formation of gastric juice, 
being changed by the lactic acid of the stomach into lactate of 
sodium, thereby setting free hydrochloric acid, which acts not only 
by aiding digestion, but in the production of pepsin from the pep- 
sinogen of the gastric tubules. The dose is 10 to 20 grains (0.65-1.3). 



Sodium Ethylate. 

Sodium Ethylate is a whitish powder, decomposed in the presence 
of water into alcohol and caustic soda, but soluble in absolute alcohol 
without decomposition. 

Sodium ethylate is employed in medicine as a depilatory — that is, 
for the purpose of removing hairy growths. To accomplish this pur- 
pose it is necessary that the growth be clipped close to the skin, and 



398 DRUGS. 

that the drug be dissolved in absolute alcohol and applied over the 
roots of the hair with a glass rod. 

Soon after this application a crust forms, which should not be 
detached for two or three weeks, but which, on its removal at the 
end of this time, generally shows that all the roots of the hair have 
been destroyed. If not, the operation may be repeated as soon as 
the skin is in a condition to bear it. To prevent pain, a 5 per cent, 
solution of cocaine may be used hypodermically at the spot to be 
cauterized. It is worthy of remembrance that moles and small birth- 
marks, or naevi, may be removed by a similar application. 

A solution, Liquor Sodii Ethylatis, is official in the B. P. 



Sodium Hyposulphite. 

Hyposulphite of Sodium, or Thiosulphite of Sodium, occurs in 
large, transparent, colorless plates which effloresce when exposed to 
the air. It has slight alkaline reaction, is soluble in about equal parts 
of water, but insoluble in alcohol. 

Therapeutics. — Hyposulphite of sodium is used in the proportion 
of 1 drachm (4.0) to the ounce (32.0) of water or lard in the treat- 
ment of parasitic skin diseases, particularly those due to the tri- 
cophyton fungus, such as pityriasis versicolor. It is also very useful, 
locally applied, in poisoning from poison ivy, and in cases of pruritus 
due to other causes, in the strength of J a drachm (2.0) to the ounce 
(32.0) of water. In malarial hematuria hyposulphite of sodium is 
often given with advantage in the dose of from 10 to 30 grains (0.65- 
2.0) every four hours. How it acts in this condition we do not know. 



Sodium Sulphate. 

Sodii Sulphas, U. S. and B. P., or Glauber's salt, is one of the most 
irritant of the saline purges, rarely used in medicine for human beings, 
but largely employed by veterinarians. The purgative dose for man 
is half an ounce to an ounce (16.0-32.0). If any intestinal inflam- 
mation is present, it is contraindicated. It produces large watery 
stools, with a good deal of griping. Sulphate of sodium is a promi- 
nent constituent of Carlsbad water, Hunyadi Janos, Hunyadi Arpad, 
and similar waters. (For an explanation of the action of salines in 
producing purgation, see Magnesium Sulphate.) 

Reverdin has recently claimed that small doses of 2 grains (0.1) of 
sulphate of sodium every hour are of great value in controlling capil- 
lar// hemorrhages and for graver hemorrhages. It must be given by 
the mouth or intravenously. If given hypodermically he asserts it is 
useless. 

Under the name of Sodii Sulphas Effervescens the 2?. P. recognizes 
mi effervescent preparation of sodium sulphate, given in the dose of 2 
fco \ drachms (8.0-15.0). 



SOLANUM CAROLINENSE— SOZOIODOL. 399 

Sodium Sulphocarbolate. 

(See SULPHOCARBOLATES.) 

SOLANUM CAROLINENSE. 

Solanum Carolinense, or Horse Nettle, is a low perennial plant of 
the natural order Solanacece, a native of the South-eastern United 
States. 

According to some studies made by Thornton the drug depresses the 
cerebrum, but excites the spinal cord. It has been introduced into 
medicine for the purpose of relieving epilepsy, particularly when the 
disease occurs in childhood. In a limited employment of the drug 
the writer has found it very serviceable in diminishing the frequency 
and severity of the attacks. The beginning dose of the fluid extract is 
15 to 60 minims (1.0-4.0) three times a day, but it can be increased to 
as much as 2 drachms (8.0) at a dose with advantage. 

SOMNAL. 

Somnal is stated to be ethylated chloral- urethran, and seems to 
possess marked hypnotic power. It is a clear, colorless liquid of a 
hot, burning taste, resembling sweet spirit of nitre. The dose is 20 
to 40 minims (1.3-2.6) in liquorice-water or syrup of raspberry, and 
the sleep produced by it is said to last seven to eight hours. In a 
number of cases in which the writer has used it it has acted very well, 
although drowsiness has usually been present on the next day. 

SOZOIODOL. 

Sozoiodol is an antiseptic preparation first made and employed by 
one of our own countrymen in San Francisco, but at that time the 
preparation of it was so imperfectly carried out that foreign matters 
made it too irritating for general use, and it was discarded, only to 
be better prepared and more widely used in Germany some years 
later. 

Therapeutics. — Sozoiodol has been found of value as an antiseptic 
and disinfectant in the treatment of ivounds which are in an unhealthy 
state, and for acute stomatitis and pharyngeal catarrh it may be 
employed locally in the form of a 5 per cent, watery solution. It 
has also been found useful in acute purulent conjunctivitis and in oph- 
thalmia neonatorum, in the proportion of 2 parts of sozoiodol to 30 
parts of water. In urethritis of a specific type we may employ the 
preparation known as zinc-sozoiodol in a 2 per cent, solution with 
advantage, and this compound is also of value in mild and malignant 
vaginitis if preceded by pyroligneous acetic acid or nitrate of silver, 
applied by means of a speculum. 

In the treatment of gynaecological cases, particularly in catarrh of 
the cervix uteri, Nitschman uses sozoiodol in the form of a powder 
applied by means of a tampon with good results, and it would seem 
to be worthy of trial in many other states of the mucous membranes 
than those just named. 



400 DRUGS. 

SPIGBLIA. 

Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia 
marilandica, or Carolina Pink, a plant of the Southern United States. 

Poisoning. — The symptoms of poisoning by spigelia very closely 
resemble those of belladonna poisoning. 

Therapeutics. — Spigelia is one of the most efficient remedies in the 
treatment of round-worms, and is not dangerous when given with 
care. When employed for the removal of worms the usual precaution 
should be taken in regard to the ingestion of food (see article on 
Worms), and the drug should be followed by a purge to sweep out 
the worm while it is narcotized. The purge should be one which is 
rapid in its action, such as the sulphate of magnesium. 

Administration. — The dose of spigelia in the form of the fluid 
extract (Extractum Spigelian Fluidum, U. S.) is 2 drachms (8.0); 
that of the unofficial fluid extract of spigelia and senna (Extractum 
Spigelice et Sennas. Fluidum) is -J- to 1 drachm (2.0-4.0) for a child 
of two years of age ; J an ounce (16.0) is the dose for an adult. The 
addition of fluid extract of senna makes the drug more efficient, and 
the mixture is generally not disliked by children. It is to be remem- 
bered that this latter mixture is no longer official. 



SQUILL. 

Scilla, U. 8. and B. P.. is the sliced bulb of Urginea maritima 
(Srilla, B. P.). a plant of the countries bordering on the Mediter- 
ranean. It contains scillin, scillipicrin, and scillitoxin, all of which 
possess poisonous properties, and none of which is used in medicine 
alone, except by a few persons. 

Poisoning. — In poisonous doses squill produces vomiting, purging, 
dulness, stupor, intermittent palsy, convulsions, and death in ten to 
twenty hours. These symptoms are preceded by a great fall in tem- 
perature. The urine is suppressed or bloody and acute nephritis is 
produced. Gastro-enteritis may be marked. 

Therapeutics. — Squill is largely used as a stimulant or irritant 
diuretic, not to affect the renal epithelium directly and promote secre- 
tion, but rather to tone up and excite to normal effort a kidney 
depressed by disease, as in very chronic Bright* 8 disease or renal con- 
gestion from cardiac trouble. In cardiac dropsy, combined with digi- 
talis, squill is a standard and much-used remedy, and is undoubtedly 
of value in aiding in the absorption of effusions in the pericardium, 
pleura, and abdomen. Squill is usually given in dropsy, in pill form, 
as follows : 

R .— Pulv. scillae gr. x (0.65). 

Pulv. digital, fol §j (1.3).— M. 

Ft. in ))il. No. x. 
S. — One t. i. (1. after meals. 

The employment of squill in bronchitis, although largely resorted 
to, is not a very good practice, since its irritant action on the kidneys 
and stomach may cause trouble. The period for its administration is 



STARCH. 401 

in the beginning of the second stage, when secretion is scanty or so 
excessive as to need proper stimulation of the mucous membranes to 
bring on a healthy action. Sometimes Coxe's Hive Syrup is used, 
either as an emetic in drachm doses every ten minutes until it acts, or 
as an expectorant in the dose of 30 minims to 1 drachm (2.0-4.0) 
three times a day for an adult. As it contains antimony, it should 
be given with care. 

Administration. — The fluid extract {Extractum Scillce Fluiclum, 
is much used in the dose of 1 to 5 drops (0.05-0.3); the tincture 
(Tincturce Scillce, JJ. S. and B. P.) in the dose of 5 to 30 minims 
(0.3-2.0); the vinegar of squill (Acetum Scillce, U. S. and B. P.) in 
the dose of 10 minims to ^ drachm (0.65-2.0). The compound syrup 
(Si/rupus Scillce Compositus), or Coxe's Hive Syrup, is composed of 
the fluid extract of squill, fluid extract of senega, tartrate of antimony 
and potassium, precipitated phosphate of calcium, sugar, and water, 
and is given in the dose of 20 minims (1.3) as a sedative to an adult 
and 1 drachm (4.0) as an emetic to a child. 

The following prescription will be found useful in bronchitis in its 
subacute stages in a child of one to five years : 

R.— Vini ipecac f JJj (4.0). 

Tincture scillee f ^ij (8.6). 

Syr. tolutan f %v (20.0). 

Aqua? f£j (30.0).— M. 

S. — Teaspoonful (4.0) every three or four hours. 

The plain syrup (Syrupus Scillce, U. S. and B. P.) is given in the 
dose of J to 1 drachm (2.0-4.0), the honey (Oxymel Scillce, B. P.) 
in the dose of J to 1 drachm (2.0-4.0), and the compound pill (Pilulce 
Scillce Composita, B. P.) in the dose of 5 to 10 grains (0.3-0.65). 



STARCH. 

Amylum, U. S. and B. P., is wheat starch, but good corn starch 
is employed by many persons. In very fine powder starch is used as 
a dusting powder in intertrigo or chafing. Its more important uses 
are, however, its employment in the form of starch-water for carry- 
ing drugs into the rectum, and in the form of a poultice for cases of 
skin disease where it is desired to remove crusts. 

Starch-water is made by adding 2 tablespoonfuls of starch to 1 
pint of water, then boiling it to a paste and diluting it by the addi- 
tion of warm water to the consistency of syrup. Starch-water is 
not only useful as a vehicle for drugs given by the rectum, but as a 
sedative injection in proctitis and rectal irritation. 

The starch poultice is made by boiling the starch to a pasty 
consistence or by adding enough boiling water to a paste made 
by rubbing cold water and starch together to produce a gelatinous 
mass. 30 grains (2.0) of boric acid to the ounce (30.0) render it 
antiseptic. 

26 



402 DRUGS. 



STILLINGIA. 



Stillingia, U. S., Queen's Root, is the root of Stillingia sylvatica, 
a plant of the United States, the active principle of which is stil- 
lingin. 

Physiological Action. — There can be no doubt that this drug acts 
in two ways : first, by its immediate effects on the system, and second, 
by its more slowly-shown alterative influences. In overdose it causes 
bilious purging, increased heart-action, and active secretion from the 
bronchial mucous membrane. 

Therapeutics. — Stillingia is highly recommended in habitual con- 
stipation, as it increases intestinal secretion, and it is even said to act 
as a specific in hemorrhoids dependent largely for their existence upon 
hepatic engorgement and intestinal atony. 

Bartholow recommends the following prescription under these cir- 
cumstances : 

R —Extract, stillingi* fluid f^v (20.0). 

Tincturse belladonnae "] 

Tincturse nucis vomica; [■ . . . . aa f £j (4.0). — M. 

Tincturse physostigmatis J 
S. — 20 drops (1.3) in water t. d. before meals. 

Tincture of aloes may also be added to this prescription if consti- 
pation is present. In syphilis of an obstinate and rapid type stillingia 
should be used as an aid to other drugs. 

In pasty-looking, white, "putty-faced" children, who are anaemic 
or strumous, and who never have any appetite, or are subject to mid- 
dle-ear trouble and general debility, stillingia is of value. It should 
be used, under these circumstances, for some time. 

The only official preparation is the fluid extract (Extract um 
Stillingia? Fluidum, II. S.), which should always be made of the 
fresh root, the dose of which is 10 to 60 minims (0.65-4.0). 



STRAMONIUM. 

Jamestown Weed, or Datura Stramonium, is official in the form of 
the leaves (Stramonii Folia, U. S. and B. P.) and the seeds (Stramonii 
Semina, U. S. and B. P). It contains an alkaloid, known as daturine, 
which is physiologically identical with atropine. 

Physiological Action. — (See Belladonna.) 

Therapeutics. — The uses of stramonium are identical with those of 
belladonna. 

Administration. — The extract (Extractum Stramonii. B. P., Sem- 
inis, U. S.) is used in the dose of -J- to i grain (0.01-0.03), the 
fluid extract (Extr actum Stramonii Seminis Fluidum, U. S.) in 
the dose of 1 to 5 minims (0.05-0.35), and the tincture (Tinctura 
Stramonii, U. S. and />. P.) in the dose of 5 to 80 minims (0.3—2.0). 
It should be remembered that this tincture is nearly twice as strong 
as the tincture prepared according to the U. S. P. of 1880. The 
ointment | Unguentum Stramonii, is also used for the same purposes 



STB 0NT1 TJM—STR OPHANTH US. 403 

•intra* 
grain (0.0005-0.0008). 



as is belladonna ointment. The dose of daturine is t -J-q to -^ of a 



STRONTIUM. 

This substance has been introduced into medicine in the form 
of the bromide (Strontii Bromidum, U. $.), lactate (Strontii Lactas, 
U. S.), iodide (Strontii Iodidum, JJ. S.\ salicylate, and phosphate, 
largely through the studies of Laborde, Se'e, Paul, and others. The 
bromide of strontium is used for precisely the same effects as are the 
other bromides, but it is claimed that, as the strontium has a distinct 
nutritive influence over the system, the well-known disadvantages of 
the potassium salt are avoided. The dose of bromide of strontium 
is from 30 to 60 grains (2.0-4.0). In addition to the ordinary effect 
of bromides, See found the bromide of strontium to be very useful in 
overcoming attacks of gastric indigestion associated with pain in the 
stomach and hyperacidity ; and the author has confirmed this state- 
ment. The lactate of strontium seems to be indicated chiefly in 
cases of albuminuria due to renal atony. It does not increase urinary 
flow, and is contraindicated in the presence of the uraemia and the 
high fever of acute parenchymatous nephritis. In chronic parenchyma- 
tous nephritis, such as is due to rheumatism or gout, it is of value. 
Unfortunately, as soon as the lactate of strontium is withdrawn the 
albuminuria is apt to recur. The writer has often been much disap- 
pointed in the use of the lactate of strontium in albuminuria, but 
others of wide experience seem to regard it as very constant in pro- 
ducing good results. The dose of the lactate of strontium is 60 to 
100 grains (4.0-7.0) a day. 

The salicylate of strontium is a valuable preparation, because it is 
not so disagreeable to the taste as the corresponding salt of sodium ; 
and, more important still, it is far less apt to disorder the stomach than 
salicylic acid itself or any of its other salts. The author has found it 
for these -reasons very useful in acute articular rheumatism, when the 
progress of the patient was delayed by the inability of his stomach 
to retain the ordinary anti-rheumatic remedies. The salicylate of 
strontium is best given in capsules or cachets, and should always be 
followed by a draught of milk or water to prevent its coming in 
contact with the stomach in too concentrated form. The dose is, 
for all practical purposes, identical with that of the salicylate of 
sodium. 

Strontium possesses no toxic power whatever, and overdoses are not 
followed by any bad consequences. If the strontium is contaminated 
by barium, serious effects are produced. 



STROPHANTHUS. 

Strojihanthus, U. #., Strophanti^ Semina, B. P., is an African plant 
(Strophanihus hispidus), from the seed of which the natives make konibe' 



404 DRUGS. 

arrow-poison. There are many varieties of Strophanthus. The active 
principle is strophanthin, from which is derived strophanthidin. It 
has been claimed that strophanthus contains a local anaesthetic prin- 
ciple, but Dr. de Schweinitz and the author found it to be possessed 
of this power only in dogs, and not in man. 

Physiological Action. — Strophanthus acts as a stimulant to the 
heart muscle and its ganglia, but does not slow the pulse by its action 
on the vagus as does digitalis. While it raises arterial pressure by the 
increased heart action, it does not stimulate the vaso-motor system to 
any extent. It is therefore useful in cases of weak heart with arterial 
spasm, since it helps the heart, but does not increase its work, by 
raising arterial tension. 

Therapeutics. — Strophanthus may be used in all forms of cardiac 
disease to supplant digitalis, but it is not its equal. 

From the cases of cardiac disease seen frequently by the writer he 
has reached the conclusion that digitalis gives relief to patients under 
the age of twelve years in a much smaller proportion of cases than it 
does in adults, and that, though the stomach is no more frequently 
disordered, increased dyspnoea, nervous irritability, and cyanosis often 
follow its use. On the other hand, strophanthus generally gives good 
results in this class of cases. 

As every one knows, there are a certain number of cases where 
digitalis seems to do harm in adults, the explanation being that under 
such circumstances the ventricle is so overstimulated that the auricle 
cannot empty itself thoroughly, and becomes congested in consequence. 
Strophanthus acts exceedingly well in those instances where digitalis 
fails, and this is particularly true in children. It will relieve cardiac 
dropsy by its action on the heart, but does not possess marked diuretic 
properties. 

Untoward Effects. — Strophanthus when given in full dose frequently 
causes diarrhoea. 

Administration. — Strophanthus is given in the form of the tincture 
(Tinctura Strophanthi, U. S. and B. P.) in the dose of 3 to 6 minims 
(0.2-0.35) three times a day. The extract of strophanthus {Ex- 
tractum Strophanthi) is now official in the B. P. The dose is J- of a 
grain (0.016). Strophanthin may be given hypodermically in the 
dose of jfo to z \ of a grain (0.0006-0.0012). Its effects when so 
used are said to last a week, but this statement can scarcely be 
correct. 



SUGAR. 

Saccharum, U. S. {Saccharum Purification, B. P.), is the refined 
juice of Saccharum officinarum, or Sugar-cane, or the juice obtained 
from the Sugar-beet. It is an antiputrefactive, but not an antifer- 
mentative. Mixed with iron preparations, it prevents oxidation. As 
it is a hydrocarbon, it is a nutrient and a developer of adipose tissue, 
or, in other words, is a food. Its use is contraindicated in obesity, 
during the existence of fermentative changes in the stomach and 
intestine, and in diabetes mellitus. 



SUGAR OF MILK—SULPHONAL. 405 



SUGAR OP MILK. 



Saccharum Lactis, TJ. S. and B. P., is derived from the whey of 
cow's milk by evaporation, in the proportion of about 5 per cent., and 
is then purified by re-crystallization. It has little sweetening power 
compared to cane-sugar and possesses a peculiar insipid taste. It is, 
however, less apt to ferment and is better for infants than is cane- 
sugar. 

Milk-sugar is largely used in triturations, because by its hardness 
it aids in the subdivision of the medicament. It is also used to 
increase the bulk of small powders where such drugs as podophyllin 
and calomel are prescribed. 

Recent studies, both scientific and clinical, have shown lactose to 
be possessed of very great diuretic power when given in full doses. 
The advantage claimed for lactose as a diuretic is its direct action on 
the kidney and the slight effect exercised upon the rest of the organism. 
It is, therefore, in renal dropsy or renal inactivity that this substance 
is particularly indicated. The dose of lactose in cases of dropsy 
should be as great as from 2 to 4 drachms (8.0-16.0), given daily, 
dissolved in a quart (1 litre) of water. It has been found that the 
lactose acts best in those cases in which there is no albuminuria. 
These recent studies are of interest in view of the well-known clin- 
ical fact that the addition of lactose to the milk of bottle-fed babies 
always causes profuse diuresis. 



SULPHOCARBOLATES OP ZINC AND SODIUM. 

The sulphocarbolates of zinc (Zinci Sulphocarbolas, B. P.) and 
sodium (Sodii Sulphocarbolas, B. P.) are largely employed by some 
practitioners as mild antiseptic local stimulants, either in powder or 
in solution, on ulcers and sores. Much more commonly they are given 
internally for the production of gastro-intestinal antisepsis when there 
is diarrhoea with foetid, ill-smelling stools, as in the bowel disorders of 
hot weather in children or adults, or in the course of typhoid fever. 
How much good they do in the latter disease, so far as the disease itself 
is concerned, is uncertain, but they undoubtedly render the stools less 
foul and tend to check the diarrhoea. The sulphocarbolate of zinc is 
the better of the two for these purposes. The dose is 2 to 3 grains 
(0.01-0.15) in pill four or five times a day. The sulphocarbolates are 
probably eliminated from the body unchanged. Sometimes good 
results follow the use of cascara sagrada with these salts in cases of 
constipation with flatulence and signs of auto-intoxication. 



SULPHONAL. 

Sulphonal, B. P., is a synthetically prepared substance first manu- 
factured in Germany by Baumann, and possesses the chemical name 
of diethyl-sulphon-dimethyl-methane. It is a colorless, odorless, solid 
substance, soluble in 100 parts of cold and 18 to 20 parts of hot 



406 DRUGS. 

"water, and is readily soluble in alcohol and ether. The drug is not 
affected by any of the ordinary acids, and is very stable. 

Physiological Action. — In medicinal doses the effect of sulphonal 
upon the lower nervous system is practically nil. The dominant effect 
is on the brain. The drug is completely changed during its passage 
through the body. On the circulation the drug has but little effect ; 
upon the respiration the drug acts as a depressant when given in 
full doses. 

Therapeutics. — Sulphonal finds its place in medicine as a somni- 
facient or hypnotic, valuable when functional nervous insomnia is 
present, useless where advanced disease, such as cardiac trouble, is 
responsible for the wakefulness. In insanity it often produces sleep, 
and is of great service in the various mental disturbances character- 
ized by lack of sleep and often affecting persons of unsound mind. 
Sulphonal may be defined very briefly by any one who has largely 
used it or watched the reports made of its progress. This definition 
is that the drug does possess sleep-producing power of moderate 
amount — not equal to chloral, but greater than that of paraldehyde — 
and that it will sometimes succeed where the other hypnotics fail. 
It has the great advantage of not being a depressant to the heart. 

Administration. — Sulphonal being virtually insoluble in cold water, 
may be given in large capsules or in mucilage of acacia, so as to be 
held in suspension until swallowed. This insolubility and bulki- 
ness of the drug render its use difficult. It is best given in hot water 
(about 6 ounces), as suggested by Stewart. This makes a solution, 
and as soon as the liquid is cool enough to be sw T allowed it should be 
taken before precipitation occurs as the result of cooling. Sulphonal 
should be used several hours — say two or three — before the patient 
retires. If taken late at night, the patient frequently fails to get to 
sleep until the morning hours, and is heavy and drowsy all the next 
day. This difficulty is partly avoided by the use of a hot solution, 
but even then is apt to arise. The dose is 20 to 40 grains (1.3- 
2.6). It is wise not to use sulphonal continuously for more than a 
few days. 

Untoward Effects. — When sulphonal is taken in full dose for long 
periods of time, great sleepiness and weariness, with an unsteady 
gait, develop, which may go on to paralysis of the lower extremities 
if the use of the drug is persisted in. In some cases the paralysis is 
progressive, and in others hyperesthesia and abnormal sensations 
develop. In all such cases there is great disturbance of digestion 
with scanty secretion of urine, which contains an unusual substance, 
giving this secretion the color of port wine (hgematoporphyrinuria). 
This is partly due to a cumulative effect of the drug. Sulphonal often 
produces mental heaviness and a staggering gait the day after it is 
taken. This can to some extent be avoided by giving a dose of some 
laxative, when the drug is taken, so that the bowels will be moved thor- 
oughly the next morning. There are a number of cases of death on 

lord from acute and chronic poisoning by sulphonal. In both classes 
of cases the death was by respiratory failure preceded by deep uncon- 
sciousness. As much as 120 grains (8.0) have been taken, however, 



SULPHUR. 407 

without ill effect, and Neisser has reported a case which recovered after 
1400 grains had been taken. Probably but a small amount of this 
dose was actually absorbed. In cases of subacute or chronic poisoning 
the prognosis is unfavorable if the symptoms are well developed. 

SULPHUR. 

Sulphur is a non-metallic element official in three forms in the 
U. S. P. — namely, as Sulphur Sublimatum, U. S. arid B. P., or sub- 
limed or flowers of sulphur ; Sulphur Proecipitatum, JJ. S. and B. 
P., or precipitated sulphur; and Sulphur Lotum, TJ. S., or washed 
sulphur. 

Much confusion exists among students as to the differences between 
these various forms of sulphur. Sulphur itself is an element which 
is prepared for medicinal uses by being heated and sublimed (Sulphur 
Sublimatum), or flowers of sulphur. Sulphur lotum, or washed sul- 
phur, is prepared in order to get rid of sulphuric acid and other con- 
taminating substances, and is made from sublimed sulphur. Sulphur 
praecipitatum is also made from sublimed sulphur, and is more bland 
and minutely subdivided. Some bejieve it differs from sublimed 
sulphur in its therapeutic properties by reason of a small amount of 
water supposed to be present. It is sometimes called milk of sulphur. 
When sulphur is prescribed for internal use the sublimed sulphur is 
generally designated. 

Physiological Action. — Sulphur has little physiological influence 
over the general system. When taken internally it causes a soft, 
mushy stool of a yellow color with a strong odor of hydrogen sul- 
phide. The drug acts particularly on the skin and mucous membranes 
as a gentle alterative. The juices of the intestines break up some 
of it into sulphuretted hydrogen and sulphides. 

Therapeutics. — Sulphur is used as a mild laxative, never as a 
purge. In stricture of the bowel the soft stools produced by it will 
often slip by the obstruction, and it is worthy of note that sulphur 
will sometimes overcome constipation when nothing else will give 
relief. It is particularly valuable in the treatment of constipation 
where there are hemorrhoids, and in chronic rheumatism and sciatica 
it is thought by some to effect a cure. 

Sulphur is of great service in the treatment of chronic bronchial 
affections, but for some curious reason its use has become almost obso- 
lete. The so-called Bergeon's method of treating phthisis by rectal 
injections of carbonic acid gas loaded with sulphuretted hydrogen was 
simply a revival of a custom of our great-grandfathers, who often used 
sulphur-waters by the mouth in the treatment of catarrhs or other 
disorders of mucous membranes. Bergeon took the trouble to go to 
the rectum to accomplish what was done two hundred years ago by 
the mouth, and the only novel part of his method was his filthy way 
of using the remedy. Graves recommended 5 to 10 grains (0.35- 
0.65) of sulphur three times a day wherever bronchial secretion w T as 
excessive, and found that it rid the lungs of mucus and relieved the 
cough. 



408 DRUGS. 

The external use of sulphur is very much more important than its 
internal use, in so far as regards affections of the skin. Of itself, 
the drug exercises little effect over the cuticle when used in powdered 
form, but combination with an ointment makes it at once active. Even 
irritations of the skin may ensue from its constant use in large 
amount. 

In scabies, or itch, sulphur ointment ( Unguentum Sulphuris, U. S. 
and B. P.) is the best remedy we have. The female parasite burrows 
under the epiderm and deposits the ova as she moves about, .while the 
male does not burrow, but stays on the surface. The ointment will 
kill him, as he is readily attacked, but the female is protected by her 
burrowing propensities. To get at her and the ova the burrows must 
be opened, and this may be accomplished by a thorough soaking of 
the body with soap and water, thereby softening the epiderm covering 
the parasite, which can then readily be removed by rubbing the 
patient with a rough towel. The towel should be boiled at once to 
prevent its conveying the parasite to others. The ointment, if now 
applied, relieves the patient almost at once. It is important that the 
skin be well softened and rubbed, in order to keep open every burrow. 
The ointment should be allowed to remain on the part all night and 
be used for three or four nights consecutively. 

Young women often suffer from acne, particularly about the men- 
strual epoch, the skin also becoming at this time sallow and muddy. 
The following ointment is one which is very successful in promoting 
a cure : 

R. — Sulphuris prsecipitat ^j (4.0). 

Lanolini . . . . gj (31.0).— M. 

S. — Apply once or twice daily. 

Administration. — Sulphur is given in the dose of 10 to 20 grains 
(0.65-1.3) three times a day as an alterative, and from 1 to 2 
drachms (4.0-8.0) at night as a laxative, with a little molasses to 
form a paste. 

A confection {Confectio Sulphuris) is official in the B. P., dose 10 
grains to 2 drachms (0.65-8.0), as is also Trochiscus Sulphuris. 



Sulphide of Calcium. 
(See Calcium, Calx, and Sulphides.) 

SULPHURIC ACID. 

Acidum Sulphuricum, U. S. and B. P., Sulphuric Acid, or Oil 
of Vitriol, is a powerful irritant and escharotic, rapidly dehydrating 
and carbonizing the tissues, causing them to become black. It is the 
mosl astringent of the medicinal mineral acids, and when absorbed it 
unites with bases to form sulphates, and is so eliminated by the kidneys, 
the Lower bowel, and the skin. It coagulates albumin. 

Poisoning. — The symptoms produced by poisonous doses are those 



SUMBUL. 409 

of a gastrointestinal inflammation of the most severe type, or the 
patient may drop to the floor almost at once, owing to collapse 
dependent upon perforation of the walls of the oesophagus or stomach 
by the acid and its consequent escape into the peritoneal cavity. If 
the patient lives to the fourth day, the parotid glands may become 
swollen as the result of stenosis of the salivary ducts of Steno, and 
violent inflammation of the kidneys may appear from the passage of 
the drug through these organs in the process of elimination. If par- 
tial recovery takes place, the patient often dies from inanition due to 
the formation of strictures in the alimentary canal or to destruction 
of the peptic tubules. The stain about the mouth is black, and if 
any of the acid is spilt on the clothes the characteristic burn is to 
be seen. 

The treatment consists in the use of alkalies, such as chalk, mag- 
nesium, whitewash off the walls, and soap. Opium and oils are to 
be given to allay irritation, and external heat is to be applied. 

Therapeutics. — Sulphuric acid is sometimes employed as a caustic 
to venereal sores, warts, and slowly-healing ulcers, but is most com- 
monly used internally, as it fulfils several pressing indications. As 
a remedy for serous diarrhoea, particularly if combined with some 
vegetable astringent, it is unsurpassed, and its use in cholera deserves 
great attention. (See Diarrhoea.) In the Philadelphia Hospital dur- 
ing an epidemic of cholera some years since every case which received 
sulphuric acid improved or failed to be attacked, whereas those who 
did not receive it were either very ill or died. 

The proper way to use the drug as a prophylactic during cholera 
epidemics is in the form of "sulphuric-acid lemonade," made so that 
each wineglassful of water contains 5 drops (0.35) of the aromatic 
sulphuric acid. The same solution may be used in acute lead poison- 
ing in order to form an insoluble sulphate of lead, and may be taken 
by artisans exposed to chronic lead poisoning as a prophylactic for 
the same purpose. 

As sulphuric acid is eliminated by the skin, it is often useful 
in the night-sweats of phthisis combined with belladonna or mor- 
phine. 

Administration. — The dose of the dilute acid (Acidum Sulphuricum 
Dilution, U. S. and B. P.) is 5 to 20 minims (0.32-1.3), and of the 
aromatic acid {Acidum Sulphuricum Aromaticum, U. S. and B. P.) 
5 to 20 minims (0.35-1.3). The latter is the best preparation for 
general use. It contains ginger and oil of cinnamon, Both prepara- 
tions should be thoroughly diluted before they are administered. 



SUMBUL. 

Sumbul, U. S., is the root of Ferula Sumbul, a large plant of 
Northern Asia. The dose of the root (Sumbul Radix, B. P.) is 10 
to 40 grains (0.65-2.65). On the nervous system sumbul acts as an 
efficient nerve tonic, and was very largely employed by Goodell in cases 
of nervous exhaustion and in the unrest of nervous females. It is 



410 DRUGS. 

official in the tincture (Tinctura Sumbul. U. S. and B. P.), dose 1 to 
4 drachms (4.0-16.0). Goodell used the following formula: 

R. — Extract, sumbul gr. xx (1.3). 

Ferri sulph. exsiccat gr. xx (1.3). 

Asafcetidae gr. x (0.65). 

Acid, arsenosi gr. ^ (0.03). — M. 

Ft. in pil. No. xx. 
S. — One t. d. after meals. 

To be of any value the drug must be fresh, and care must be taken 
that the crude drug from which it is made is a good sample. 



SUPRARENAL GLAND AND ADRENALIN. 

The suprarenal gland, or its active principle, has become within 
the last few years one of our most valued remedies. Its chief use in 
medicine depends upon its extraordinary power of producing contrac- 
tion of small blood-vessels and capillaries with which it is brought in 
contact. It also exercises a marked constricting effect on the blood- 
vessels of the general arterial system when given internally. 

The medullary portion of the glands is chiefly concerned with the 
elaboration of the active physiological principle, which has recently 
been isolated by a Japanese chemist, Takamine, and called adrenalin. 
Adrenalin occurs in tiny, almost microscopic white crystals of various 
forms, which are soluble in water after slight acidulation with hydro- 
chloric acid. 

Physiological Action. — Locally applied extract of this gland, or 
adrenalin, produces great blanching of mucous membranes by reason 
of its powerful constriction of the capillaries of the part. So great 
is this constriction that the tissues are practically bloodless while its 
influence lasts. This local effect is due to stimulation of the muscular 
fibres in the blood-vessel walls. Its use is not followed by the great 
relaxation and congestion seen after the local application of cocaine to 
a mucous membrane. Given internally, it slows the pulse by stimu- 
lation cf the vagus nerves and by the increased arterial pressure due 
to the resistance to the free flow of blood in the vessels. It also 
increases the force of the systole of the heart by stimulating its mus- 
cular fibres. Part of the rise of blood-pressure after its internal use 
depends in all probability on a stimulant effect exercised upon the 
vasomotor centre. Upon the venous system its effects may be ignored. 

Therapeutics. — Because of its extraordinary power in constricting 
blood-vessels of small calibre adrenalin is a remedy in all forms of 
hemorrhage from such vessels, particularly if it can be locally applied. 
Thus it can be employed in epistaxts, Menorrhagia, metrorrhagia, and 
for the purpose of controlling hemorrhage in operations on the nose, 
throat, ear. or larynx. It can also be employed to relieve the en- 
gorgement of the nasal mucous membrane in eases of eoryza and hag 
>'■ ver, and in trachoma and conjunctivitis. 

Internally suprarenal extract, or adrenalin, is employed in cases 
of cardiac and vasomotor failure or lack of vascular tone, and to 



SWEET SPIRIT OF NITRE. 411 

overcome the dangerous vascular relaxation sometimes occurring in 
chloroformization. 

Administration. — Suprarenal gland may be employed as an extract 
of the gland, when it is used internally in the dose of 3 to 5 grains 
(0.18-0.03) three times a day or oftener. By far the best form in 
which to use it is adrenalin chloride in normal salt solution, 1 : 10,000 
to 1 : 1000. Adrenalin may be given internally in tablet or capsule, 
and when used locally is employed by wetting a pledget of cotton with 
the solution named and then pressing it lightly against the part 
which it is desired to affect. Blanching comes on in a few moments. 
Its solution may also be sprayed on the part by means of an atomizer. 

SWEET SPIRIT OP NITRE. 

Sweet Spirit of Nitre (Spiritus JEtheris Nitrosi, U. S. and B. P.), 
or Spirit of Nitrous Ether, is a mixture of alcohol, water, and ethyl 
nitrite. It is upon this last constituent that most of its value as a 
remedial agent depends. The drug when sold by pharmacists or 
others who are not very careful to keep fresh preparations is no better 
than alcohol and water alone, since the ethyl nitrite readily escapes, 
and deterioration at once takes place. Until recently the profession 
have had no ready means of protecting themselves from such poor 
preparations, but at present we know that all that is necessary to dis- 
cover this absence is to add a grain or two of antipyrin to a J ounce or 
less of the spirit. If the ethyl nitrite be present, a purple color fol- 
lowed by a green precipitate will be formed. This green precipitate is 
iso-nitroso-antipyrin, which is not in the least poisonous. 

Physiological Action. — Sweet spirit of nitre is a sedative to the cir- 
culatory and nervous system as are all the nitrites (see Nitrite of 
Amyl), and a diaphoretic and diuretic, according to the manner in 
which it is administered. 

If given in very full doses, it rapidly produces the cyanosis char- 
acteristic of the full effects of any one of the nitrites. (See Amyl 
Nitrite.) 

Therapeutics. — There is probably no drug so widely employed by 
the laity as a household remedy which is so potent for good, and yet 
so harmless, if wrongly used, as is this one. 

Physicians often place less reliance upon it than it deserves, and 
in nearly every instance where it fails it is either not indicated or the 
nitrous ether has escaped and left it powerless. 

In incontinence of urine in children the combination which follows 
is very useful in certain cases. (See Incontinence of Urine.) In these 
instances the urine will be found high-colored and concentrated, and 
therefore capable of irritating the bladder and genito-urinary tract : 

R. — Potassii citratis £j to ^ij (4.0-8.0). 

Spt. setheris nitrosi f.ifss (15.0). 

Aquae destill q. s. ad fjiv (120.0).— M. 

S. — Dessertspoonful (8.0) every five hours until the urine becomes clear. 

As soon as the urine is clear, belladonna may be used, the citrate 
of potassium and spirit of nitre being continued or not as the case 



412 DRUGS. 

demands. Where the spinal centres are depressed and there is gen- 
eral atony of the system, it may be well to substitute the following 
pill for the belladonna : 

R. — Acid, arsenosi gr. \ (0.016). 

Extract, nucis vomicae gr. ij (0.1). 

Quininae sulphatis - . . . . gr. xx (1.3). — M. 

Ft. in pil. No. xx. 
S. — One pill t. d. after meals. 

The diuretic action of sweet spirit of nitre is best obtained by 
using the drug in ice-cold water and keeping the patient lightly cov- 
ered and cool. On the other hand, if a diaphoretic influence is 
desired, it may be given simultaneously with warm lemonade, and 
the patient should be well blanketed. This last action of sweet spirit 
of nitre has made it a remedy of common use in treating acute colds 
in adults and children, and in setting aside the fever of these condi- 
tions in the latter class as well. 

Sweet spirit of nitre is a distinct antispasmodic, and can be well 
employed where slight nervous excitement accompanies fevers or in 
other states associated with nervous irritation in infancy. 

The dose for an adult is from 20 minims to 1 drachm (1.3-4.0), 
and for a child of one year 5 to 10 minims (0.35-0.65). It should 
always be given in cool water to the latter class of patients. 



TAMARINDS. 

Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus 
indica, a tree of the West Indies. 

The taste is a peculiar mixture of bitter and sweet. As a laxative 
it exerts little power over that of any ordinary fruits, such as apples, 
but it enters into the confection of senna (Confectio Sennoe, U. S. 
and B. P.). Patients often find tamarinds a very agreeable laxative 
when they are taken before going to bed or eaten as a confection after 
meals. 

TANNIC ACID. 

Tannic acid (Acidum Tannicum, U. S. and B. P.) when pure is 
an uncrystallizable, white or yellowish-white powder, without bitter 
taste and very soluble in water and glycerin. It is not soluble in alco- 
hol or ether. It is the chief active principle of vegetable astringents, 
and occupies the relative position of an alkaloid to a crude drug, so far 
as the active portion of these vegetable astringents is concerned. Tan- 
nic acid is derived from nut-gall. 

Physiological Action. — Tannic arid when brought in contact with 
any of the tissues of the body constringes them and decreases their 
vascularity for a time, by causing contraction of their blood-vessels. 
For these reasons it stops secretion and condenses parts of the body 
which are relaxed and feeble. Mixed with blood, it forms a clot with 
_ ■ ii rapidity through coagulation of the albumin. Tannic acid is 



TANSY— TAB. 413 

absorbed as gallic acid and eliminated as such, only acting as tannic 
acid before absorption. This is important to remember, since we 
learn from this that tannic acid is to be used to check hemorrhage 
only where the drug can be brought in direct contact with the bleed- 
ing point. If a hemorrhage is to be reached through the circulation, 
as in renal bleeding, gallic acid is to be given, as it is absorbed at 
once without change. 

Therapeutics. — Tannic acid is used in medicine to control hemor- 
rhage, and to act as an astringent to relaxed tissues, as in diarrhoea 
of the atonic or serous type, or in localized or general sweating. It 
is also of service for the purposes of toughening mucous membranes 
or parts of the skin which are exposed to much rubbing, as in the 
case of the nipples of a primipara, or where the feet become mace- 
rated and sore or sweat profusely on exercise being taken. In the 
treatment of haemoptysis tannic acid may be dissolved in water in the 
proportion of 5 to 10 grains (0.32-0.65) to the ounce (30.0) and used 
in a fine spray delivered from an atomizer. Glycerite of tannin is 
made by adding 2 ounces (62.0) of tannic acid to a \ pint (250 cc.) of 
glycerin, and mixing at a gentle heat until solution occurs. It is use- 
ful as an application to slow ulcers and depressed mucous membranes, 
as after an attack of stomatitis. In hemorrhoids of the bleeding type 
tannic acid suppositories are often very useful, and cotton saturated 
with tannic-acid solution is often used as a packing in vaginal leu- 
corrhoea. 

Administration. — The dose of tannic acid is 2 to 10 grains (0.1- 
0.65), best given in pill. The official preparations are — the troches 
[Trochisci Acidi Tannici, U. S.), each containing 1 grain of tannin; 
the Gilyceritum Acidi Tannici, U. S. ; Collodium Stypticum, U. S. ; 
and an ointment {JJnguentum Acidi Tannici, IT. S.). The B. P. 
preparations are — Gilyceritum Acidi Tannici; Suppositoria Acidi 
Tannici, each containing 3 grains (0.15); and Trochisci Acidi Tan- 
nici, of which each contains J grain (0.03) of the acid. 



TANSY. 

Tansy [Tanacetum, U. S.). The leaves and tops of Tanacetum 
vulgar e yield a volatile oil {Oleum Tanaceti) which possesses em- 
menagogue powers and has been largely used as a uterine stimulant. 
It is also used, as an anthelmintic. 

In poisonous dose it causes epileptiform convulsions in some cases, 
and deep coma, with death from respiratory failure. 

The dose of the oil as an emmenagogue is 1 to 3 drops (0.05- 
0.15). 

In domestic medicine tansy tea, made by adding 1 ounce (30.0) of 
the leaves or tops to 1 pint [\ litre) of water, and given in the dose 
of 1 to 2 ounces (30.0-60.0), is largely employed as a remedy for 
amenorrhoea. 

TAR. 

(See p. 369.) 



414 DRUGS. 



TARAXACUM. 

Taraxacum {Taraxaci Radix, B. P.), Dandelion, is a very old 
remedy for hepatic torpor and the dyspepsia resulting therefrom. It 
should be prepared from the fresh leaves or roots, as the dried, stale 
plant is inert. From disregard of this fact much disappointment has 
arisen. Owing to its being bitter it acts as a tonic. The extract 
(Ext r actum Taraxaci, U. 8. and B. P.), dose 5 to 30 grains (0.35- 
2.0), and the fluid extract (Extr actum Taraxaci Fluidum, U. 8. ; 
Liquidum, B. P.), dose 1 to 3 drachms (4.0-12.0), are the only 
official preparations. Succus Taraxaci, B. P., is given in the dose 
of 1 to 2 drachms (4.0-8.0). 



TARTARIC ACID. 

Acidum Tartaricum, U. 8. and B. P., is derived from crude 
potassium bitartrate, and is much less powerful than acetic acid, but 
capable of producing very severe gastro-enteritis if taken in overdose 
and in concentrated form. It is rarely used alone, and is most com- 
monly employed to act upon sodium or potassium bicarbonate to form 
effervescent drinks. (See Seidlitz Powder and Effervescing Draughts.) 
The dose is 5 to 20 grains (0.35-1.3). 

When tartaric acid is taken in poisonous dose, lime-water, alkalies, 
and magnesium are the antidotes, and opium is to be given to allay 
irritation. If necessary, emetics are to be used. 



TEREBENE. 

Terebenum, U. 8. and B. P., is a liquid substance, clear, color- 
less, insoluble in water, having a peculiar odor like that of new 
pine sawdust, and is made by the action of sulphuric acid upon oil 
of turpentine, which is then distilled at about 160° F, 

Therapeutics. — Terebene is a very useful stimulating expectorant, 
to be used in the late stages of acute or in chronic bronchitis to liquefy 
and get rid of the mucus which is clogging the bronchial tubes. The 
drug may be given byway of the stomach or by inhalation. A useful 
mixture in the later stages of bronchitis when the mucus is very thick 
and tenacious is one composed of equal parts of terebene, iodide of 
ethyl, and chloroform, placed on a sponge and held some two or three 
inches from the face. It has also been employed in genito-urinary 
inflammations of a subacute or chronic form in place of oil of sandal- 
wood or copaiba as a stimulant. In fermentative dyspepsia it is of 
service as an antiseptic. The drug should always be given in cap- 
sules in the dose of 5 to 10 minims (0.35-0.G5), or by dropping it on 
sugar in the same amount. This dose may be repeated every three 
hours. Unfortunately, terebene is very apt to irritate the stomach or 
to produce diarrhoea, and it sometimes irritates the kidneys. 



TEBPINE HYDRATE— THAPSIA. 415 

TBRPINB HYDRATE. 

Terpine Hydrate (Terpini Hydras, TJ. S.) is prepared by a certain 
process, unnecessary to explain, from a mixture of pure oil of tur- 
pentine, alcohol, and nitric acid. In this manner large, colorless crys- 
tals, without odor and with a faint taste, are formed, and in this form 
the drug appears on the market. Terpine hydrate is soluble in 250 
parts of cold, 32 parts of boiling water, and in 10 parts of alcohol. 
In ether it requires 100 parts for its solution, and in chloroform 200 
parts. 

Therapeutics. — Terpine hydrate is used for the purpose of increas- 
ing secretion from the bronchial mucous membrane, and is a useful 
remedy in subacute or chronic bronchitis to rid the tubes of mucus. 
The drug has also been satisfactorily employed in the treatment of 
hay fever when given in full doses. The remedy, while only useful 
in a limited number of conditions, certainly seems to be very useful 
in the variety of diseases named. The dose as generally given is 2 
to 3 grains (0.1-0.15), but it may be given in the dose of 15 to 20 
grains (1.0-1.3) three times a day in hay fever. Terpine hydrate 
may be prescribed in pills, capsules, and in alcoholic solution flavored 
with some of the aromatic waters and with the addition of a little 
syrup. Thus : 

R. — Terpin. hydrat gr. lxxv (5.0). 

Spt. vini gallici f^ij (60.0 J. 

Syrup, lactucarii, 

Syrup, tolutan aa f^iij (90.0):— M. 

S. — 1 to 2 dessertspoonfuls (0.8-15.0 J three or four times a day. 

Or we may prescribe — 

R.— Terpin. hydrat, gr. xl (2.65). 

Acid, benzoic gr. xl (2.65). 

Codeinse gr. v (0.3). — M. 

Ft. in pil. No. xx. 
S. — 1 pill three or four times a day. 



TERPINOL. 

Terpinol is derived from terpine hydrate by boiling the latter with 
dilute mineral acids. Terpinol occurs as an oily substance smelling 
like hyacinths. It is almost insoluble in water, but dissolves readily 
in ether and alcohol. It is used for precisely the same purposes as 
terpine hydrate, in the dose of 8 to 20 grains (0.5-1.3), in capsules 
or pills. This dose may be given twice or thrice a day. The drug 
may irritate the stomach and kidneys when given in overdose. 



THAPSIA. 

Thapsia garganica is an umbelliferous plant of South-eastern 
Europe, employed for the purpose of producing a blister. It is gen- 



416 DRUGS. 

erally used under these circumstances in the form of a plaster. The 
resin, obtained from the bark of the root, is the form in which it 
appears in medicine. When applied continuously it produces great 
irritation, and finally sloughs appear. 



THIOCOL. 

Thiocol is derived from guaiacol, the chief active ingredient of 
creosote, and is, technically speaking, potassium guaiacol-sulphonate. 
It appears in white fine crystalline powder possessing a slightly bitter 
and salty taste, and is readily soluble in water and in diluted alcohol. 
Thiocol is used in medicine as a substitute for creosote and guaiacol 
in the treatment of clironic bronchitis and tuberculosis of the lungs, 
and is given in the dose of 10 to 30 grains (0.65-2.0) three times a 
day. Its advantages are its comparative tastelessness, its ready 
absorbability, and the fact that it does not irritate the stomach. It 
may be given in powder on the tongue or in capsule. 



THIOL. 

Thiol is a substance introduced into medicine as a substitute for 
ichthyol, as the latter drug possesses the disadvantage of having a 
disagreeable odor. It is derived from brown-colored paraffin or gas 
oils by a complicated process. The product obtained is evaporated in 
vacuo to a thin extract called Thiolum Liquidum, or still further to dry- 
ness, or Thiolum Siccum. The liquid thiol occurs as a thin brownish- 
black neutral fluid, smelling somewhat like birch oil. It is slightly 
soluble in alcohol and ether, but quite soluble in water, forming a 
clear mixture, which is rendered more perfect by the addition of 
glycerin. Thiol sicca may appear in lustrous scales. 

Therapeutics. — The question which arises at once in regard to thiol 
is, Avhether the fact that thiol is practically an artificial ichthyol 
necessarily indicates that it can be used as a substitute for that sub- 
stance ? While it is true that they are both sulphur compounds, it is 
also true that ichthyol possesses very extraordinary powers not met 
with in any other form of sulphur compound previously known. Thiol 
has been used largely by skilful observers in diseases of the skin in 
moist eczema, scrofulosis of the skin, and in syphilides with asserted good 
results. In cases of moist eczema the thiol is used, after first wash- 
ing the part with an antiseptic solution, by dusting it over the skin 
in tlie form of powder. Bidder has treated the disease by using com- 
presses wet with thiol in 10 per cent, solution. 

While it is claimed that thiol will relieve exudations about joints 
and elsewhere in as effective a manner as ichthyol, sufficient evidence 
as to this point is not yet before us. Thiol is much cheaper than 
ichthyol. 



THIOSJNAMINE— THYMOL. 41 7 

THIOSIN AMINE. 

Thiosinamine is a preparation derived from volatile oil of horse- 
radish, or more commonly from the volatile oil of mustard seed, by the 
addition of alcohol and ammonia water and exposing it to heat. Under 
these conditions crystals of thiosinamine are deposited in prisms which 
are soluble in 2 parts of warm water, and in alcohol or ether. A solu- 
tion of it should not redden litmus paper. 

This substance is used in medicine for the cure of lupus in scars y 
and keloid, and it has been used with asserted success in malignant 
groivths. In a case of keloid the drug in 10 per cent, solution in 
absolute alcohol may be injected directly into the part affected in the 
dose of 10 to 20 minims (0.65-1.3) every third or fourth day. The 
part receiving the injection usually becomes congested and swollen and 
dark in hue. There is often a great increase in the urine, and per- 
haps nausea and vomiting, and great pain where the injection is given. 
In cases of lupus it may be injected locally or at a distant spot, and 
produces a reaction like that caused by tuberculin. The drug may 
also be given internally in the dose of 4 to 6 grains (0.2-0.4) once a 
day. 

THYMOL. 

Thymol, IT. S. and B. P., is derived from the oil of thyme and 
other volatile oils, and occurs in large crystals. It is almost insoluble 
in water, but is freely soluble in fats and oils. Thymol is irritant in 
large amount. It is antiseptic and disinfectant, and has been employed 
in typhoid fever as an intestinal antiseptic by Henry and others. 
Under these conditions it should be used in gelatin-coated pill, and a 
glass of water or milk taken to avoid the burning sensation otherwise 
produced. In the treatment of stomatitis or tenderness of the gums 
after mercurialization the following mouth-wash may be used : 

R— Thymol gr. x (0.65). 

Sodii boratis gr. xv (1.0). 

Aquae fgij (64.0).— M. 

S. — Place a teaspoonful (4.0) of this in J a tumblerful of water and use as a gargle. 

Thymol has been used for dressing wounds, but is too costly. In 
summer weather it cannot be employed, because of its power of attract- 
ing flies, which make the patient's life miserable. The dose is \ to 2 
grains (0.03-0.1), in capsule or in wafer, and it is better to follow its 
use by a glass of milk to prevent the drug from irritating the stomach. 
In typhoid fever as much as 30 grains (2.0) in twenty-four hours may 
be given as an intestinal antiseptic. 

If very large amounts (100 grains [T.0]) are taken in a day, poi- 
soning may result, but as much as this must be used before danger is 
present. 

Thymol Iodide. 

This compound of iodine and thymol, sometimes called aristol, but 
more correctly dithymol diiodide, has been introduced into medicine 

27 



418 DRUGS. 

for the purpose of substituting iodoform. It does not possess the 
unpleasant odor of iodoform, and it is stated to be less apt to produce 
poisoning by absorption. A great deal of contradictory experience 
has accumulated as to its exact value, but the result of a careful 
examination of clinical reports is that in some respects it is a better 
drug than iodoform and in others not so good. Tichhoff and Neisser 
state that when taken internally thymol iodide is incapable of causing 
toxaemia, but this can only be true when moderately large doses are 
given. Upon cocci and bacilli thymol iodide has less power than 
iodoform. In regard to the power of this drug in healing wounds 
or sores, the decision has been reached that whenever secretion is free 
it is contraindicated, as the thymol seems to increase moisture. On 
the other hand, in those instances where in disease of the skin or 
mucous membrane an undue dryness is present the effect produced is 
often favorable. Upon lupus little effect is produced unless the sur- 
face is first curetted. Finely-powdered thymol iodide has been found 
of very unusual value in the treatment of interstitial keratitis by de 
Schweinitz and Wallace when dusted into the eye each day. In an 
ointment of \ to 1 drachm to the ounce of lard (2.0-4.0 : 32.0) thy- 
mol iodide may be used in psoriasis, but it is not as useful as is 
chrysarobin in this affection. 



THYMUS GLAND. 

The Thymus Gland has been used quite largely in certain diseases 
on the same principle as that governing the use of the thyroid, namely, 
that this gland possesses the function of internal secretion and will 
therefore benefit certain systemic conditions in persons in whom the 
thymus was atrophied too early in life. Others have used it as a sub- 
stitute for the thyroid, intentionally or by mistake. 

Its chief use has been in the treatment of goitre (not exophthalmic). 
It does not produce any disagreeable effects as does the thyroid. 
Usually the beginning dose is half an ounce (15.0) administered sev- 
eral times a week. This dose is soon increased to an ounce (32.0) 
once a week. In this country several firms prepare thymus gland in 
tablets and capsules ready for use, and this is the best form in which 
to prescribe it. 

THYROID GLAND. 

The Thyroid Gland has been introduced into therapeutics within 
the last few years for the purpose of relieving certain disturbances of 
nutrition of which the most characteristic are myxocdema and cretin- 
ism. The results obtained from its use in these states are extraordi- 
nary, and it is to be regarded as a specific. Its use is based upon the 
fact that in cases of myxcedema the thyroid gland is usually found 
atrophied, and on the discovery by Reverdin, Kocher, Schiff, Fuhr, 
Ilorsley, Credo', Zesas and others, that extirpation of this gland pro- 
duces myxocdema or a train of symptoms practically identical with it. 



THYROID GLAND. 419 

Soon after these studies had been verified it was suggested that myxe- 
dema might be cured if it were possible to transplant part or all of the 
thyroid gland of one of the lower animals to the body of the patient 
affected, with the hope that this healthy glandular tissue would become 
vascularized and exercise its beneficent influence on the disease process. 
This method has been attempted again and again, nearly always with 
good results, which, however, have been only temporary because the 
transplanted gland has not become well vascularized and has been 
gradually absorbed. When this operation is attempted the gland of the 
sheep is chosen, because it most closely resembles that of man and its 
removal from the sheep causes in that animal symptoms very like those 
seen in a man suffering from disease or absence of the thyroid gland. The 
animal is killed by a blow or by shooting, an incision is at once made, 
under absolute antisepsis, and one lobe of the gland is rapidly dis- 
sected out and placed in a warm, sterile glass jar in which it is con- 
veyed to the surgeon, who stands ready to make an incision into the 
subcutaneous tissues of the trunk just below the breasts. The lobe 
is split in two and one-half placed in each incision and the wounds are 
closed and treated like any ordinary surgical wound. Only normal 
sterile saline solution should be used in the wound. If good results 
persist after six months the gland has become vascularized and 
the operation does not have to be repeated ; but if a return of the 
symptoms comes on in three months, a new graft will have to be 
made. 

The objections to this method are so numerous that Murray admin- 
istered thyroid gland by the mouth and its extract hypodermically, 
with great success, and he has been followed by many others. The 
gland itself may be eaten in the dose of from one-eighth to one whole 
lobe each day, but the latter is far too large a dose in most cases. As 
it is disagreeable to take it raw T , it may be very lightly fried or broiled 
or even boiled before it is eaten ; but these processes diminish its 
activity. In other cases the gland may be minced and spread on 
bread with anchovy sauce. 

If fresh thyroid cannot be had daily, a glycerin extract may be 
used. The minced gland is covered by an equal weight of pure 
glycerin, and then after soaking for twenty-four hours is placed in a 
cloth and firmly squeezed for some time to extract the glycerin laden 
with the active ingredients of the gland. This will keep for a long 
time, and may be given daily in the dose of 3 to 15 minims. It is, 
however, far better for the physician to employ the desiccated thyroids 
in powdered form or made into a tablet or placed in a capsule than to 
use the crude preparation just named. A number of firms in this 
•country and abroad prepare the gland and market it in this form, and 
even prepare an extract. Thus the extract of thyroid gland prepared 
by a well-known firm is of such a strength that 1 grain equals 10 
grains of the crude gland or one-sixth of a desiccated thyroid. The 
dose of this is half a grain three times a day, which dose is gradually 
increased as the patient becomes accustomed to it. It is probably 
better, however, to use the desiccated powdered thyroid itself, which 
is now placed upon the market in capsules and tablets. This prep- 



420 DRUGS. 

aration is far more satisfactory than the various substances isolated 
from the gland by chemical means and is easily ingested. Two 
grains of desiccated powdered gland are equal to 5 grains of the fresh 
gland, the ordinary sheep's thyroid weighing about 24 grains. When 
the remedy is first employed we usually employ about 1 grain of desic- 
cated powdered gland, which is gradually increased a grain a day until 
about 6 grains a day are reached, when a halt is made and the effect 
of this dose watched for some days. If the patient does not manifest 
symptoms of overdose on the one hand or fail to improve on the other, 
then the dose may be further gradually increased. No more than 15 
grains of the dried gland should be given each day, and this quantity 
should be divided into several doses. 

Thyroid gland has been used very largely in the treatment of cre- 
tinism with success only second to that attained in the therapy of 
myxoedema, and with asserted success in dwarfism, excessive obesity, 
psoriasis, and scleroderma. The rapid growth of cretins under thy- 
roid gland therapy may lead to bending of the bones, and care should 
be taken that too much exercise on the feet is prevented. When used 
in obesity an increased amount of nitrogenous food should be supplied,, 
to prevent loss of strength, as this gland causes not only increased 
catabolism in the fatty, but also in the proteid parts of the body. 
Under its influence the body cannot assimilate glucose if it is ingested 
in full doses, and glycosuria develops. In obese diabetics the gland 
is probably a dangerous drug for this reason. In the author's experi- 
ence its effects are inconstant in obesity. It benefits some patients 
and is useless in others. Because of the very great effect of this 
gland upon nutritional processes it has been employed in a host of 
ailments in which there has been no prospect of producing good effects. 
Among these, however, some experiments have resulted so favorably 
that the use of the gland has received recognition, although we do 
not understand exactly how it does good. Thus in the dose of from 
5 to 20 grains (0.35-1.3) three times a day, according to the degree 
to which it produces its effects, it has proved of value in acute mania 
and melancholia, puerperal and climacteric insanities, and in stuporous 
states with primary dementia. The treatment should be persisted in 
for at least thirty days, according to Mabon and Babcock. It has 
also been asserted that thyroid therapy is useful in the treatment of 
exophthalmic goitre, but this is quite positively contradicted. Indeed, 
it is claimed by some that this disease is made worse by its use, since 
in overdose the gland causes symptoms like those of exophthalmic 
goitre. Probably it will be found that true exophthalmic goitre is 
not benefited, but it may be that the gland is useful when simple 
hypertrophy of the connective tissue of the thyroid produces the 
enlargement. 

Thyreoiodine and Iodothyrine have been introduced as representing 
the therapeutic activity of the crude gland ; but while they possess 
some action, they cannot be so used witli the expectation of such good 
results as when the desiccated thyroid gland itself is resorted to. 

In the B. P. the dried gland (Thyroideum Siceum) is official, as is 
also TAquor Thyroidei, dose 5 to 15 minims (0.3-1.0). 



TRICHLORACETIC AC1D—TRI0NAL AND TETRONAL. 421 

Untoward Effects. — Overdoses of thyroid produce violent headache, 
feeble action of the heart, and sometimes diarrhoea and vomiting. 
Should any of these symptoms come on they are an indication for the 
complete stoppage of the use of the drug for some days, and a return 
to its use must be gradual. These symptoms can be avoided by cau- 
tious dosing and by keeping the patient in bed for some days after 
the treatment is inaugurated. A vegetable diet will also aid the 
treatment. 

After marked improvement or apparent cure has been effected by 
the treatment, it is necessary for the patient to continue using thyroid 
extract indefinitely, for if it is stopped the myxcedema returns. The 
remedy may be given in minute daily doses or in full doses for several 
days at the end of every three weeks or a month. Though the latter 
plan is the more disagreeable it is asserted to possess a greater thera- 
peutic and. preventive value. 



TRICHLORACETIC ACID. 

Trichloracetic Acid is a compound of chlorine and acetic acid 
occurring in deliquescent crystals and used as a rapid, active eschar- 
otic upon venereal and other warts. A peculiarity in its effect is that 
it produces a dry scab which speedily falls off, leaving a healing surface 
beneath. It is also claimed that its action is not followed by secondary 
inflammation and pain. It is used by applying a crystal to the wart 
or other growth. 

TRIKRBSOL. 

Trikresol consists in a combination of ortho-, meta-, and paracresol, 
bodies allied to creolin and carbolic acid. Trikresol appears in com- 
merce as a white liquid, smelling somewhat like creosote, and soluble 
in water in the proportion of about 2-J- per cent. It forms a clear 
solution, and does not benumb the skin as does carbolic acid. It is 
also much less irritant and less poisonous than carbolic acid or bichlo- 
ride of mercury. 

Therapeutics. — Trikresol is used as an antiseptic in surgery in 1 
per cent, solutions. In the strength of 1 : 500 to 1 : 1000 it may be 
employed as an antiseptic collyrium in ophthalmic practice, in which 
field it has proved very useful. 



TRIONAL AND TETRONAL. 

These two substances are very closely related to sulphonal, and 
are practically identical with that drug in their effects on the general 
system. They occur in shining, odorless, colorless plates with a very 
faint taste. Trional and tetronal are used for the relief of insomnia 
of a functional type, and the sleep produced by these ordinarily comes 
on in about twenty to thirty minutes after the drug is taken, and lasts 
five to six hours. The dose is 15 to 30 grains (1.0-2.0). Doses larger 
than 15 to 30 grains should never be given continuously, and it is 



422 DRUGS. 

always a good plan after the drug has been given for five or six con- 
secutive days to stop its use for two or three days. It is well to order 
for the patient who is taking trional, if there is any tendency to con- 
stipation, one of the saline purgatives daily. 

Trional and tetronal are slightly soluble in water and very soluble 
in alcohol. Advantages in their use are lack of disagreeable taste and 
the absence of symptoms of circulatory depression. The best way to 
administer trional or tetronal is in hot broth or tea or whiskey. It is 
wise to gradually decrease the dose if the drug is taken night after 
night. Tetronal is more expensive than trional, but sometimes suc- 
ceeds when trional fails. Both of these drugs are apt to make the 
patient very drowsy the day after their ingestion. 

When trional is taken in full dose for several weeks, it pro- 
duces very distinct alterations in the blood, which are manifested 
by hsematoporphyrinuria — a state in which the urine is dark red or 
almost black. The drug should be stopped at once when the urine 
begins to be red and saline purgatives must be used freely. 



TURPENTINE. 

Terebintliina, U. S., occurs in two forms — namely, as turpentine 
derived from the ordinary yellow pine (Pinus palustris) and other 
varieties of pine, and as Canada turpentine (Terebinthina Canadensis, 
U. S. and B. P.) derived from Abies balsamea, or silver fir, or species 
of cone-bearing trees other than Pinus palustris. The turpentine 
derived from the latter sources is sometimes called " Balm of Gilead." 

Much confusion often exists in students' minds as to the difference 
between oil of turpentine (Oleum Terebmthince, U. 8. and B. P.) and 
spirit of turpentine, both of which are the same substance under a 
different name. This oil is not, however, the same thing as " tur- 
pentine," for the oil is distilled from turpentine. The distilled oil 
is a thin, clear fluid having a peculiar odor and taste, and is irritant 
to the skin and mucous membranes. It is exceedingly inflammable, 
should never be placed near a light, and if added to any strong min- 
eral acid takes fire. 

When turpentine is spoken of in this book or in medicine gen- 
erally, the doubly distilled oil of turpentine (Oleum Terebinthince 
Ilectificatum, U. S.) is what is meant unless the contrary is stated. 

Physiological Action. — Turpentine when taken internally produces 
a sense of warmth in the stomach, a quickened pulse, a warm skin, 
and slightly accelerated breathing. In overdose it may cause intoxi- 
cation. Upon the circulation it produces a very slight rise of arterial 
pressure, increased pulse-rate, and increased heart-force. On the 
nervous system the drug, in large amounts, causes loss of sensation 
before it affects voluntary motion. 

The drug is eliminated by the kidneys and lungs, and gives the 
odOr of violets to the urine. 

Poisonous doses cause strangury, bloody urine, renal inflammation, 
and cyanosis, with dilated pupils and gastro-enteritis. 



TURPENTINE. 423 

In persons with an idiosyncrasy to this drug, erythematous, papular 
or vesicular eruptions may follow its external or internal use. 

Therapeutics. — External Use. — Turpentine is used as a local 
application for the purpose of producing counter-irritation over any 
area where deep-seated inflammation exists. Under these circum- 
stances it is almost always used in the form of a stupe, made as fol- 
lows : Place a tin cup containing the turpentine in a vessel containing 
hot water, so that the turpentine may be warmed without coming near 
a flame. Dip a piece of flannel into very hot water and wring it out 
in a twisted towel, and when it is so dry that no water drips from it, 
dip it into the hot turpentine and wring it out again to free it from 
any excess of the drug. The cloth, while hot, should be applied, and 
allowed to remain until discomfort ensues, when it should be with- 
drawn, as it will blister the skin if left on too long. Children and 
adults suffering from bronchitis may be rubbed on the chest with tur- 
pentine with much relief, but in the former class of patients it should 
be diluted with sweet oil, half and half, or even two-thirds of oil. 

Internal Use. — Turpentine is used internally as a stimulant of 
a diffusible type in the course of the exhausting fevers, particularly 
if any flatulence exists or if any ulceration of the bowels is present. 
In typhoid fever turpentine stupes, turpentine enemata, and the 
administration of the drug by the mouth are the best ways to over- 
come tympanites. At the end of the second week, when the tongue 
is red, dry, cracked, and brown, the teeth covered with sordes, and 
tympany is well marked, turpentine may be used in emulsion in the 
dose of 5 to 10 minims (0.8-0.65) three times a day with advantage. 
Again, in convalescence from typhoid fever, when diarrhoea is per- 
sistent and relapses are constant and due to an unhealed state of 
Peyer's patches, turpentine is the remedy par excellence. 

In intestinal and other passive hemorrhages, such as menorrhagia 
or hematuria, the drug is often of service. 

Used against the tape-worm, turpentine is given in the dose of 
^ an ounce to 1 ounce (15.0-30.0), mixed with an equal amount of 
castor oil. This treatment is a somewhat dangerous practice, but is 
efficient. In chronic and well-advanced kidney disease very large 
doses of powerful diuretics are often required to stimulate the kidneys 
sufficiently to increase urinary flow, and turpentine may be used under 
these circumstances, but it is contraindicated if any acute irritation is 
present, as it may under these conditions produce suppression. 

Turpentine is contraindicated in the presence of any acute inflam- 
mation of the g astro-intestinal tract and in acute nephritis. 

In lumbago the dose of 2 minims (1.3) is said to be very useful, 
and many have found the vapor of turpentine of value in bronchitis of 
a subacute or chronic type when inhaled from boiling water. (See 
Inhalations, Part III.) In gleet it is given by the mouth to stimu- 
late the genito-urinary tract. Turpentine should be tried in the treat- 
ment of purpura hemorrhagica, as it has been found of value. 

Administration. — Turpentine may be given for the relief of flatu- 
lence by placing 5 minims (0.3) on a piece of sugar, or in an emulsion 
made by using acacia and a flavoring substance, as follows : 



424 DRUGS. 

R. — 01. cinnamomi gtt. xx (1.3). 

01. terebinthina? f^iv (15.0). 

Mocil. acacia 3 q. p. ad f,^iv (120.0). — M. 

S. — A tablespoonful (4.0) every four hours in typhoid fever. 

A more agreeable preparation, not to be used in typhoid fever, is 
that recommended by Bartholow, as follows : 

R .— Olei terebinthina- f%j (4.0). 

Olei amygdal. expres f^ss (16.0). 

Tinctura? opii f^ij (8.0). 

MuciL acacise f^v (20.0). 

Aquae lanro-cerasi fSss (16.0). — M. 

S. — A teaspoonful (4.0) every four hours for tympanites. 

When used as an enema the following is useful : 

R .—Olei terebinthina? f^j (32.0). 

Olei olivae fSjss (48.0). 

Camphor* gr. xx (1.3). 

Mucil. acacia; f^ss H6.0). 

Aquae f^x (320.0).— M. 

S. — To be injected as an enema for the relief of tympanites and to aid in the removal 
of hardened faces. Stir thoroughly before using. 

The Liniment of Turpentine [Linimentum Terebinthince, U. S. 
and B. P.) is largely used as a stimulating application to sprains and 
enlarged joints. 

The following preparation is also official in the B. P. : Linimentum 
Terebin ih in a? A cetic u m . 

Turpentine applied with a brush to the part affected is of service 
in ringworm. 

The ointment of turpentine is used as a counter-irritant and stimu- 
lant to the part to which it is applied. The liniment acts in the same 
way when applied to sprains and bruises. 



UROTROPIN. 

Urotropin is made by the action of ammonia upon formaldehyde, 
and when taken internally it sets free the formaldehyde in the urine. 
It is used to render the urine acid and clear when this secretion is 
excessively alkaline, loaded with phosphates and amorphous urates, 
and purulent. It allays irritability of the bladder due to this cause, 
as, for example, in ammoniacal cystitis. It has recently been employed 
to render the urine sterile in cases of typhoid fever and as an intestinal 
antiseptic. The dose is 3 to 7 grains (0.15-0.35), taken twice or thrice 
a day. dissolved in a half pint of carbonated or plain water. 

Several cases have been recorded in which the continued use of 
large doses has resulted in producing hematuria. 



UVA URSI. 

I'm Ursif U. S., Bearberry, is the leaves of Arctostaphylos Uva 
nisi. ;i widely-distributed evergreen shrub. The drug is known in 



VALERIAN— VALERIANIC ACID. 425 

the B. P. as Uvoe Ursi Folia. Its active principle is arbutin, some- 
times called ursin. 

Therapeutics. — Uva ursi is employed in medicine as a weak, astrin- 
gent diuretic, possessing alterative power over the genito-urinary appa- 
ratus. It is used in pyelitis, cystitis, and in chronic gonorrhoea or 
gleet. When taken in overdose it escapes from the body as hydro- 
chinone, making the urine dark-colored or black. 

Administration. — Arbutin itself is often used in the dose of 3 to 5 
grains (0.15-0.35). The dose of the extract (Extr actum Uvoe Ursi, 
U. S.) is 1 to 4 grains (0.05-0.2), of the fluid extract (Extr actum 
Uvoe Ursi Fluiclum, U. S.) is 2 to 4 drachms (8.0-16.0) three times 
a day. An infusion (Infusum Uvoe Ursi) is official in the B. P., 
dose 1 to 2 ounces (30.0-60.0). 



VALERIAN. 

Valerian (Valeriana, U. S.) is the rhizome and rootlet of Vale- 
riana officinalis, a plant of Europe, but cultivated in America. It 
is oflicial in the B. P. as Valeriana? Bhizoma. Its active principle 
is apparently a volatile oil (Oleum Valerianae). It also contains 
valerianic acid. 

Physiological Action. — Valerian is a very feeble depressant to the 
nervous system, tending to produce nervous rest. In male cats it 
excites sexual activity to a great degree, probably from its, odor. 
When very large doses are given to man, it causes a sense of warmth 
in the stomach, a slightly quickened pulse, and sometimes nausea and 
vomiting. Still larger amounts produce purging and mental hebetude. 

Therapeutics. — ■■ Valerian is used alone or in combination with other 
drugs to quiet nervous females and to relieve nervousness and insom- 
nia. In hysteria it is often very serviceable, and combined with 
morphine is much used in the treatment of delirium tremens. 

Administration. — The fluid extract (Extr actum Valerianae Fluiclum, 
U. S.), is given in the dose of 1 fluidrachm (4.0), and the ammoniated 
tincture (Tinctura Valerianae Ammoniata, IT. 8. and B. P.), in the 
dose of 1 to 3 drachms (4.0-12.0). These are the best preparations for 
ordinary use. The infusion, which is not oflicial, is given in the dose 
of a wineglassful, while that of the simple tincture (Tinctura Valeri- 
anae^ U S.) is 1 to 3 drachms (4.0-12.0). The dose of the oil 
(Oleum Valeriana*) is 2 to 4 minims (0.05-0.2). 

VALERIANIC ACID. 

Acidum Valerianicum is an oily, colorless liquid of a strong odor 
and burning taste, but is not employed in medicine except in the form 
of' its salts, such as the valerianate of zinc, iron, quinine, or ammo- 
nium, all of which are employed, partly for their sedative effects and 
partly for their influence as tonics. 

The dose of Zinci Valerianae is \ to 3 grains (0.03-0.15), that 
of Quinince Valerianas, U. S., 1 to 3 grains (0.05-0.15), of Ferri 



426 DBUGS. 

Valerianae 2 to 10 grains (0.1-0.65), and of Ammonii Valerianas 
2 to 10 grains (0.1-0.65). Under the name of " the pill of the three 
valerianates " Goodell recommended the following in nervousness and 
hysteria : 



R. — Quininae valerianat. *| 

Ferri valerianat. > aa 9 j (1.3). — M. 

Ammon. valerianat. J 
Ft. in pil. No. xx. 
S. — One or two three times a day. 



VERATRINA. 

Veratrina, U. S. and B. P., is an alkaloid derived from the seeds 
of Asagroea officinalis, and occurs in a grayish powder, which, if it 
enters the nose, produces violent sneezing which lasts for hours. 

Physiological Action. — Nervous System. — Veratrine has little 
effect on the cerebrum, but it excites the spinal cord and the volun- 
tary muscles, thereby giving rise to tetanic or tonic convulsions, 
which are never clonic or epileptoid. The dominant action of the 
drug is paralytic, and the nervous symptoms just named soon give 
place to paralysis. The muscles lose their contractile power and the 
nervous centres are depressed. 

Circulation. — In poisonous dose the heart is slowed by the drug, 
greatly weakened, and finally stopped in diastole, and is found after 
death to be soft and flabby. In smaller doses it at first slows the 
pulse by stimulating the peripheral inhibitory nerves and the centres 
in the medulla, but later these parts are paralyzed. It first stimulates 
the vasomotor centre, then paralyzes it. 

Respiration. — The drug kills by failure of respiration, due to 
paralysis of the respiratory centres. 

Temperature. — Veratrine always causes a fall of bodily heat. 

Poisoning. — The symptoms of poisoning in man are collapse, a 
pale, cold, wet skin, pinched features, and a rapid, thready pulse, 
accompanied by violent vomiting and muscular tremors. Tetanic 
convulsions may come on and resemble those of strychnine in that 
they arise from the slightest touch or draught of air ; after death the 
muscles will be found to have lost their irritability. 

Therapeutics. — Veratrine is never used internally. It is employed 
chiefly in the form of an ointment rubbed into the skin over parts 
affected by muscular rheumatism and rheumatic joints and over neu- 
ralgic nerves. The official ointment (Unguentum Veratrina?, U. S. 
and B. P.) or the oleate (Oleatum Veratrince, U. S.) should be used, 
the latter most carefully, as absorption of the drug may take place in 
sufficient quantity to poison the patient. 

VERATRUM VIRIDE. 

Veratmm Viride, U. S., Indian Poke, Poke-root, or Swamp 
Hellebore, is an American plant largely used for the purpose of 
allaying inflammation. Until recently it was official in the B. P. 
under the name of Veratri Viridis lihizoma. 



VERATRUM VIRIDE. 427 

It probably contains a number of principles, the chief of which 
are, however, jervine and veratroidine. 

Yeratrum viride is the safest and best circulatory depressant that 
we have for use in adults. 

Physiological Action. — The physiological action of this drug is to 
be considered under the effects of its two alkaloids before the com- 
plete effect is studied. 



Jervine. 

When jervine is given in full toxic dose it causes great slowness 
of movement, relaxation of the muscles, through which thrills con- 
tinually run, and finally the animal falls to the ground. Violent epi- 
leptiform convulsions may now ensue, but no tetanus is present. The 
convulsions soon give place to paralysis, and are characterized by 
their lack of force. Sensation is not affected until the near approach 
of death brings on anaesthesia. There is no evidence of gastro- 
enteritis and no vomiting or purging. The saliva is always increased 
and pours from the mouth. Death results by failure of the respira- 
tory centres and an almost simultaneous failure of the heart. The 
heart and circulation are greatly depressed, and the pulse-rate and 
force are far below their normal rate and strength. 

The blood-pressure is very low, except when the convulsion pro- 
duces a temporary rise, but the condition of the vagi is apparently 
normal. Jervine acts as a direct depressant to the vasomotor centres. 
The convulsions are due to the disturbance of the circulation at the 
base of the brain (Wood), and the spinal cord is directly depressed by 
the action of the jervine on its motor tracts. 



Veratroidine. 

This alkaloid is much more irritating than jervine, and in over- 
dose causes vomiting and purging. The muscular twitchings and 
convulsions caused by jervine are also produced by veratroidine, but 
are generally not so severe. It also depresses the spinal cord in its 
motor tracts. 

On the circulation veratroidine slows the pulse by stimulating the 
pneumogastric centres, but finally quickens it if given in very large 
doses, by paralyzing the peripheral vagi. 

The following summary, given by Wood, of the circulatory effect of 
veratrum viride, from a study of its alkaloids, is so brief and terse as 
to be worthy of insertion here : u Veratrum viride slows the pulse by 
a direct depressant action on the heart-muscle (jervine) and by stim- 
ulating the pneumogastric nerves (veratroidine) ; it lowers blood-pres- 
sure by an action on the heart-muscle (jervine) and by depression of 
the vasomotor centre (jervine)." 

Poisoning. — Veratrum viride, while one of the most powerful drugs 
we have, is one of the least dangerous, since it almost invariably causes 
vomiting before enough of the drug is absorbed to produce serious 
consequences. The vomiting is partly due to the veratroidine and 



428 DRUGS. 

partly to the presence of an irritant resin. In poisoning, cardiac 
stimulants, atropine, external heat, the placing of the head below the 
feet on an inclined plane, and the use of strychnine as a respiratory 
and nervous stimulant are to be resorted to. 

Therapeutics. — The chief use of veratrum viride is as a circula- 
tory sedative in acute, sthenic, or dynamic inflammations. In pneu- 
monia^ pleurisy, acute hepatitis, peritonitis, and cerebritis it is of the 
greatest value if given at the proper stage, when only congestion 
or hypenemia is present. After the onset of the lesions following this 
period its use is not only valueless, but harmful. The objection 
to the employment of veratrum viride in peritonitis and cerebritis lies 
in its tendency to produce vomiting, which is, of course, harmful when 
the peritoneum is inflamed. For this reason aconite is preferred to 
veratrum viride in peritonitis. Owing to its physiological influence 
veratrum viride bleeds a man into his own blood-vessels, and the indi- 
cations for its use are the same in inflammation as they would be for 
bleeding. In puerperal fever it has been highly recommended, but 
must be most carefully employed. With a large number of practi- 
tioners veratrum viride is considered by far the best remedy in 
puerperal eclampsia. If given in this condition, the dose must be 
large, as much as 20 to 30 minims (1.3-2.0) of the fluid extract 
hypodermically, and followed by 5-minim doses till the pulse is 
reduced to the normal rate. Its use is indicated only in the cases 
with high arterial tension, a bounding pulse, and suffused face. It 
probably acts in eclampsia chiefly by its depressant effect on the motor 
tracts of the spinal cord. It is also of value in excessive cardiac 
hypertrophy and in the irritable heart of strong, healthy men. In 
aneurism, where the circulatory disturbance is great and the arterial 
pressure high, the drug may be used, with great care, to decrease the 
pressure and prevent rupture of the diseased vessel. 

Contraindications. — Veratrum viride is contraindicated in all 
conditions of depression or exhaustion, and if vomiting is feared. It 
must not be given in peritonitis or gastritis, as it may cause emesis, 
and in this way disturb and irritate the abdominal contents. 

Administration. — The drug in inflammation should be given every 
half-hour or hour, and at least 1 minim (0.05) of the fluid extract should 
be used each time in a healthy adult. In the course of two or three 
hours or less the skin becomes moist or relaxed, the pulse slower and 
less excited, and slight nausea may be present. These symptoms show 
that the drug is exerting its influence, and it should now be withdrawn 
or in very sthenic cases pushed a little farther. If vomiting comes 
on before the drug has acted on the circulation, 5 to 10 minims (0.35- 
0.65) of laudanum should be given fifteen minutes before each dose 
of veratrum viride. A good preparation to employ is the tincture 
( Tinctura Veratri Viridis, U. S.), dose 3 to 6 minims (0.15-0.3). 
The fluid extract (Extractum Veratri Viridis Fluidum, U. S.) is 
given in the dose of 1 to 3 minims (0.05-0.15). Under the name of 
Norwood's Tincture a saturated tincture is largely sold. It is not 
official, and ought never to be used. 



VIENNA PASTE— WARBURG'S TINCTURE. 429 



VIENNA PASTE. 

Potassa cum Oalce, XT. $., is a milder and more manageable eschar- 
otic than is caustic potash, and is used for the same purposes. (See 
Caustic Potash.) 

WARBURG'S TINCTURE. > 

Warburg's Tincture is a complex liquid formed by the mixing 
together of no less than thirteen ingredients. Its inventor, Dr. War- 
burg, held its composition as a secret for a time, but finally made it 
public. Since he published the original formula it has been consid- 
erably altered, and some of the preparations now sold as Warburg's 
tincture contain none of the original ingredients. Further than this, 
some of these ingredients are now not obtainable. It ought to be 
made as follows, if possible : 

Aqueous extract of aloes 28 grains. 

Khubarb - 448 " 

Angelica-seed 448 " 

Elecampane ... 224 " 

Saffron 224 " 

Fennel 224 " 

Gentian 112 " 

Zedoary-root • . . 112 " 

Cubeb 112 " 

Myrrh ■ 112 " 

White agaric 112 " 

Camphor 112 " 

Sulphate of quinine • 1280 " 

Dilute alcohol enough to make 8 pints. 

The coarse vegetable portions of this list are to be ground into a 
coarse powder, and the myrrh and camphor, which have been pre- 
viously pulverized, added to them. The entire mass, less the quinine, 
is then digested for twelve hours in a well-covered vessel on a water- 
bath, the alcohol being prevented from evaporating as much as pos- 
sible. The liquid is now to be strained under pressure and the sul- 
phate of quinine added and dissolved. 

Therapeutics. — Warburg's tincture, next to pilocarpine, is the most 
powerful sweat-producer that we have, and possesses in addition very 
remarkable antimalarial power. Its advantages rest in its favorable 
action where congestions accompany the malarial paroxysm. 

Administration. — To be of any value Warburg's tincture should 
be given according to the following rules : The bowels of the patient 
should be first opened thoroughly by a saline purge, and -|- an ounce 
(15.0) of the tincture should be given in one dose undiluted, no other 
drink being taken. After the lapse of two or three hours a second \ 
ounce (15.0) is given in the same way, and very shortly a profuse sweat 
appears, which often marks the crisis of the disease, and recovery 
soon takes place. 



430 DRUGS. 

XEROPORM. 

Xeroform, or Tribromphenol-bismuth, is, as is seen from its second 
name, a combination of bromine, carbolic acid, and bismuth. It was 
introduced as a substitute for iodoform in surgical dressings. Its 
chemical constitution indicates that it possesses antiseptic properties, 
and its drying power and great volume enable it to render a wound 
antiseptic. As it does not contain any iodine, it naturally lacks the 
peculiar virtues of iodoform, and, on the other hand, has none of 
its peculiar disadvantages. 

ZINC ACETATE. 

Zinci Acetas, U. S. and B. P., occurs in the form of white mica- 
ceous crystals, which are efflorescent and quite soluble in water. It 
acts as a decided astringent to the skin and mucous membranes, but 
is less astringent than the sulphate of zinc. It is used as a collyrium 
in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains 
(0.05-0.1) to the ounce (30.0). In gonorrhoea it is often employed 
instead of the acetate of lead in injections of the strength of 1 to 20 
grains (0.05-1.3) to the ounce (30.0) of rose-water. 

The treatment of poisoning by acetate of zinc is that adapted to 
gastro-enteritis. (See Gastro-enteritis, Part IV.) 

Chronic poisoning by zinc :s very rare ; the symptoms consist in 
muscular palsies, neuritis, and cachexia. 



ZINC CARBONATE. 

Precipitated Carbonate of Zinc [Zinci Carbonas Proscipitatus, U. S.; 
Zinci Carbonas, B. P.) is used as a protective, rather astringent pow- 
der over surfaces affected by weeping eczema or other skin lesions 
accompanied by similar moist discharges. It may be employed to fulfil 
all the indications commonly treated by the oxide of zinc. It is very 
largely used, not as the precipitated carbonate, but as the impure or 
native carbonate, under the name of calamine. 

The following prescription is useful for moist eczema : 



R.— Calamine 3J (4.0). 

ting, zinci oxidi 3vij (28.0). — M. 

S. — Apply to the eczematous spot. 

In cases of infantile intertrigo, or redness of the buttocks and gen- 
itals, from maceration due to liquid faeces in infants suffering from diar- 
rhea, or where the urine is irritating, the following lotion is very use- 
ful indeed: 

R. — Pulv. calamine ) -- „.. tQr>\ 

Pulv. zinci oxidi / ' ,ia o1 *' ^ ' '" 

Glycerini ftiv (16.0). 

Al.oholis f|ij (G4.0). 

Aquae q. 8. ad Oj (£ litre). — M. 

S. — Apply with a mop after each removal of the diaper. 



ZINC CHLORIDE— ZINC SULPHATE. 431 

ZINC CHLORIDE. 

Chloride of Zinc (Zinci Chloridum, TJ. S. and B. P.) is a white, 
crystalline, deliquescent powder, of caustic taste and acid reaction, 
possessing considerable disinfectant power. It has been used as an 
eye-wash in the strength of 1 to 2 grains to the ounce (0.06-0.10: 
30.0), but is rarely so employed at present. The same solution may 
be used as an injection in the second stage of gonorrhoea. Small 
cutaneous cancers, particularly if near blood-vessels, may be advan- 
tageously treated by the following salve, which is efficacious and 
mummifies the tissues so that hemorrhage is prevented : 

R.— Zinci chloridi &' (4.0). 

Pulv. amyli sjiij (12.0). 

Cocainse hydrochlorat gr. xxx (2.0). 

A quae destillat. . • 3ij (8.0).— M. 

S. — Apply as a paste. 

Under the name of Liquor Zinci Chloridi, TJ. S. and B. P., is pre- 
pared a solution of the salt for disinfecting purposes of the strength 
of about 50 per cent. 



ZINC SULPHATE. 

Zinci Sulphas, TJ. S. and B. P., is a white, somewhat efflorescent 
salt, of a sharp acid taste, and is soluble in water. In large amounts 
it acts as an irritant, and is employed as an irritant peripheral emetic 
in the dose of 10 to 30 grains (0.65-2.0). It is not so severe as sul- 
phate of copper in its emetic and poisonous properties, and may be 
repeated if the first dose does not produce vomiting. In weak solu- 
tions it may be used as an astringent application by injection in gon- 
orrhoea and other affections of the urethral mucous membrane. In 
2-grain (0.1) pills it is sometimes given in serous diarrhoeas, particu- 
larly if it be combined with opium or minute doses of podophyllin (-g 1 ^- 
of a grain [0.001] at a dose). In conjunctivitis and other eye affec- 
tions the drug is used in the form of a wash. (See Conjunctivitis.) 



PART III. 

REMEDIAL MEASURES OTHER THAN DRUGS.- 
FOODS FOR THE SICK. 



ACUPUNCTURE. 

This is a term applied to the insertion of a small pointed instru- 
ment into the tissues of any part of the body for the purpose of 
relieving pain, swelling, or dropsies. When used in painful affections 
it accomplishes its best results in lumbago and sciatica, particularly 
in the former. When treating lumbago in this manner the writer 
takes two darning-needles, places them in boiling water to render 
them aseptic, inserts them at right angles to the skin to the depth of 
one to one and a half inches, and allows them to remain in place for 
several minutes. They are then slowly withdrawn, care being taken 
to prevent them from breaking off. Often after this treatment the 
patient can at once move more freely, to his great delight. Ringer has, 
with his usual clear clinical insight, noted that this treatment is more 
successful in those who have bilateral pain than in those who have one 
side affected, and the writer has found this statement invariably true. 

In sciatica acupuncture is less successful than it is in lumbago, but 
is always to be tried. The needle should be carried down until it 
reaches the nerve, and perhaps pierces its sheath, and it must be 
absolutely aseptic. Bartholow has recommended the use of a hypo- 
dermic needle for the simultaneous injection of a few minims of chlo- 
roform or morphine. Sometimes the best results are reached from 
inserting the needle immediately below where the nerve finds exit 
from the pelvis. In other cases it is asserted that the insertion of a 
needle on the sound side over a spot corresponding to that which is 
sore may do good. Acupuncture is useless in acute rheumatism and 
for the lumbar pain produced by fevers. 

Sometimes a rhigolene spray may be used to freeze the skin over 
the parts with advantage in lumbago or sciatica. 

Acupuncture is occasionally resorted to for the relief of dropsy, 
but it is not commonly employed, although it is often a useful meas- 
ure. When the skin of the limbs becomes so tense with an effusion 
as to endanger its life, the tension should be relieved by incisions, 
not punctures ; but saline purges are better for the removal of dropsy, 
if they can be used. Punctures rapidly close and make hard spots, 

28 433 



434 REMEDIAL MEASURES OTHER THAN DRUGS. 

while incisions remain open and permit free drainage. Immediately 
after the incisions are made the parts are to be dressed with cotton 
previously saturated with boric-acid solution and dried, or by absorb- 
ent cotton sterilized by baking it in an oven. It is hardly necessary 
to point out that the incision must be made under antiseptic precau- 
tions. (See Antiseptics.) 

ANTISEPTICS. 

The term "antiseptic," as generally used, does not necessarily 
imply the power to destroy pathogenic germs. Any substance which 
inhibits the growth of micro-organisms, which destroys or renders 
innocuous the poisonous products of their action upon the tissues of 
the body, or which retards or prevents the absorption of such products 
is properly termed antiseptic. Since germicides necessarily possess 
antiseptic attributes, they should, strictly speaking, be classed with 
antiseptics ; in this portion of the work, however, only such drugs as 
are sufficiently innocuous to allow of their use in the human body or 
upon its surface will be considered. Some of these — as, for instance, 
carbolic acid and bichloride of mercury — are efficacious solely from 
their germicidal properties. Others, and of this class iodoform is the 
most important and typical example, exert their influence, not upon 
the micro-organisms, but upon the toxic substances formed by these 
organisms. 

Of the long list of antiseptics which have within recent years 
received warm commendation at the hands of individual writers, 
there are comparatively few which have retained the confidence of 
the profession after prolonged trial. Only these few well-proven 
drugs will be discussed in this article. 

Heading the list, and in its germicidal power surpassing all others, 
is Bichloride of Mercury. Long since, the researches of Koch have 
shown that this salt is efficacious as a germicide in a watery solution of 
1 : 50,000. He states, however, that where albumin is present the 
bichloride is decomposed and rendered inert. The same change is ob- 
served when solutions are allowed to stand for some length of time, 
even when distilled water is used as a solvent. By the addition of 
either sodium chloride or a weak acid such decomposition is prevented. 

From this it follows that under ordinary circumstances solutions 
of bichloride should be freshly prepared, or, if it is desirable to keep 
tli cm for a long time, a sufficient amount of sodium chloride should 
be added to prevent precipitation of the mercury salt. Koch advised 
that as much salt should be added as would equal the weight of the 
sublimate. Other observers, however, have advised ten times this 
weight of sodium chloride. 

Since whenever bichloride solutions are used in wounds or in cavities 
of the l)od v they are brought in contact with blood-serum or other 
albumin-bearing substances, care must be taken that the antiseptic 
powers of the mercury lotion are not destroyed by the decomposition 
of* \\< active principle. The power of the solution may be preserved 
by using it in such large excess that the small amount of chemical 



ANTISEPTICS. 435 

change has practically no effect, or by combining with it, as stated 
above, an acid which will not in itself be unduly irritating to raw 
surfaces. This end is accomplished by tartaric acid. In making up 
a solution 1 part of bichloride and 5 parts of tartaric acid are added 
to as much water as is needed. Thus, in making up a solution of 
1 : 1000 for surgical purposes, the following prescription may be 
employed : 

R. — Hydrarg. chlorid. corros. . . . . gr. xv (1.0). 

Acid, tartaric gr. xv vel ^j (4.0). 

Aquse dest Oij (1 litre). — M. 

Bichloride solutions are used in the strengths of 1 : 500, 1 : 1000, 
1 : 2000, and 1 : 4000 in the treatment of ordinary wounds. For 
the irrigation of large cavities solutions of a strength greater than 
1 : 10,000 should rarely be employed, and even these dilute lotions 
have, when used in the peritoneal cavity, given rise to toxic symp- 
toms. The 1 : 2000 solution is the one generally employed for steril- 
toms. The 1 : 2000 solution is the one generally employed for steril- 
izing wounds and irrigating during operations. The stronger solu- 
tions of 1 : 500 or 1 : 1000 are used in cleansing the surface of the body. 

The ordinary method of preparing a surface of the body for oper- 
ation is as follows : The part is first thoroughly scrubbed with green 
soap and warm water, is shaved, and is washed as before. It is then 
cleansed with alcohol or ether, after which a scrubbing with bichloride 
solution of 1 : 1000 should follow. If no surgical interference is im- 
mediately indicated, the whole operative region should be enveloped in 
towels wrung out in a solution of 1 : 2000, and kept thus protected 
until the surgeon is prepared to operate. The moment the skin is 
incised no lotion stronger than 1 : 2000 should be employed, or if the 
more powerful solutions are used they should immediately be flushed 
out with one of less strength. The dressings, unless some particular 
form is used, may consist of boiled, bleached, and sun-dried gauze, 
soaked in a 1 : 500 bichloride solution and subsequently washed and 
wrung out in a 1 : 4000 dilution of the same antiseptic. 

Next in order of popularity among the antiseptic preparations is 
Carbolic Acid and its solutions. The particular value of this drug 
lies in the fact that its potency is equally developed in both albumi- 
nous and non-albuminous solutions. Like the mercury salts, its great 
disadvantage lies in its toxic properties. It is usually used in solu- 
tions of 1 : 20 and 1 : 40. The carbolic acid of commerce is found 
in liquid form. In making the solution for surgical purposes an 
ounce of this liquid is added to 20 or 40 ounces of water, according 
to the strength of the solution desired. Although carbolic acid is 
soluble in 15 parts of water, this solution does not take place imme- 
diately, and in making solutions of a strength of 1 : 20 either the 
water must be hot or a certain amount of time and considerable agi- 
tation of the mixture are required, otherwise globules of almost pure 
carbolic acid are deposited in the bottom of the tray or vessel into 
which the solution is poured, and these, by coming in contact with 
instruments or with the hands of the operator, exert an undesirable 
cauterant effect. 



436 REMEDIAL 3IEASURES OTHER THAN DRUGS. 

The 1 : 20 solution is used for the disinfection of instruments and 
the cleansing of surfaces. For half an hour before an operation it is 
customary to submerge all instruments which will be required in a 
solution of this strength, and when the surgeon is ready to use these 
instruments the solution is diluted to 1 : 40 by the addition of an equal 
volume of water which has been boiled. If a carbolic lotion is em- 
ployed for irrigation or for cleansing sponges during an operation, it 
should not be stronger than 1 : 40. 

A property possessed by carbolic acid, which renders it an unsafe 
medium for the impregnation of gauze, is its volatility. After an 
exposure of a few hours to the atmosphere it entirely evaporates, 
leaving not an antiseptic, but simply a sterile, dressing. This fact is 
utilized by the surgeon in the preparation of the deeper layers of the 
dressing, which come in immediate contact with the lips of the wound. 
Since all antiseptics are more or less irritating to raw surfaces, heal- 
ing will be promoted by a sterile rather than by an antiseptic appli- 
cation. By moistening a piece of boiled and sun-dried gauze, suf- 
ficiently large to cover the wound-edges, in a carbolic solution of 1 : 
20 the antisepticity of this dressing is assured, and in a very few 
hours the heat of the body causes the entire evaporation of all the 
carbolic acid, leaving a sterile, non-irritating surface in contact with 
the wound. If protective is used or oiled silk is applied beneath the 
dressing, these materials should be treated with carbolic acid in the 
same way. 

In addition to its toxic effect upon the patient, carbolic acid greatly 
irritates the hands of the surgeon, and if used in a strength of more 
than 1 : 40 causes so much benumbing of tactile sensibility that 
manipulative skill is seriously interfered with. The cracked and fis- 
sured fingers resulting from the use of carbolic lotions are familiar to 
all, and at times produce results of far more serious import than tem- 
porary pain and discomfort : many recesses are provided in the depths 
of which septic germs may successfully resist the action of antiseptic 
washes. There can be no question that septic poisoning has been 
frequently due to this fact. It is absolutely impossible to disinfect 
cracked or fissured hands. 

Formalin, which is a 40 per cent, aqueous solution of formalde- 
hyde gas, is a powerful disinfectant, but when used in efficient strength 
is both painful and irritating. In the strength of 1 : 2000, using nor- 
mal saline solution as the diluent, it may take the place of bichlo- 
ride lotion for flushing large cavities or cleansing extensive gran- 
ulating surfaces. The vapor has its most useful application in 
disinfecting rooms, barracks, dressings, and instruments. (See Dis- 
infection.) 

Iodoform occupies a unique place among antiseptics in having 
been almost universally accepted and used by surgeons and clinicians 
in spite of the fact that its germicidal action has been proved by 
laboratory research to be practically nil. It is found that nearly all 
forms of pathogenic germs grow abundantly upon culture materials 
the greater part of which is made up of iodoform, and that injections 
of such germs, mingled with large quantities of iodoform, produce 



ANTISEPTICS. 437 

the characteristic effect upon living tissues with almost as great cer- 
tainty as though this drug had not been used ; furthermore, it has 
been shown that iodoform is not even sterile, and that as employed 
by surgeons it is frequently a cause of infecting previously aseptic 
wounds ; moreover, it is poisonous. 

In spite of this overwhelming evidence against it the drug is still 
in favor. Recent researches have explained, in part at least, the 
reason for this contradiction between experimental and practical results. 
It has been well said that the human body is not a test-tube, and 
that bacteriological research cannot supplant the evidence of clinical 
observation. Elaborate investigation showed that this drug acts 
as a powerful antiseptic, not by destroying the germs, but by under- 
going a decomposition in their presence, the products of which render 
the ptomaines, the result of germ-growth, inert. In this way sup- 
puration is, to a certain extent, inhibited, or if present its disastrous 
effects upon the system at large are prevented, since these are due 
to ptomaine absorption rather than to a direct effect of the micro- 
organisms themselves. It has been apparently proved that ptomaines, 
in themselves and without the presence of micro-organisms, can gen- 
erate pus, but that where such ptomaines are mixed with iodoform 
before infection no pus is formed. If these septic chemical compounds 
are rendered inert, a powerful adjuvant to the destructive action of 
the germ upon living cells is removed, and thus the system is often 
enabled to overcome one enemy where two would have prevailed. The 
fact that iodoform is in itself not sterile is, from a practical stand- 
point, most important. Fortunately, sterilization is readily accom- 
plished. A thorough washing in a 1 : 1000 bichloride solution destroys 
all micro-organisms, and the powder, after being washed with freshly- 
distilled water, may then be used without fear of producing infection. 

It will be readily understood from the foregoing that iodoform is 
of little service in aseptic wounds ; that it becomes of utility in direct 
proportion to the foulness of discharge ; and that to exert its influence 
it must be applied directly to the part. It is liable, in suppurating 
wounds, to form a hard crust with the discharges, thus frustrating 
one of the most important indications in antiseptic surgery — i. e. 
drainage. Particular care should be exerted to see that the exuda- 
tion from the surfaces of the wound has a free exit. 

As employed in surgery, iodoform, after having been sterilized, is 
placed in small pill-boxes or wide-mouthed jars, over the opening of 
which is tied a single layer of antiseptic gauze ; through this the iodo- 
form is sprinkled as desired over wound surfaces. 

Kreolin, or Creolin, a preparation obtained from English coal by 
dry distillation, has been steadily and rapidly growing in popular 
favor, and because of its feeble toxic action is often preferred to car- 
bolic acid. In addition to its powerful germicidal effect, it is non- 
irritant and practically non-toxic. The claim first advanced that this 
preparation was absolutely non-poisonous can no longer be supported, 
since cases have been reported where toxic symptoms have followed 
its use: these were probably due to individual idiosyncrasy, a factor 
which we can never hope entirely to overcome. It is certainly true 



438 REMEDIAL MEASURES OTHER THAN DRUGS. 

that kreolin is the least poisonous of all the powerful antiseptics 
heretofore used. As an additional advantage, in place of the harsh, 
irritating effect produced upon surfaces by carbolic-acid solutions, 
kreolin exerts an influence very like that of an oily or mucilaginous 
preparation. 

The extravagant claims advanced for kreolin in regard to its 
germicidal property have not been confirmed by bacteriological inves- 
tigation. In solutions containing albumin it is not efficient as a germ- 
icide in strengths of less than 1 : 100, its power being somewhat 
below that of carbolic acid; since, however, its toxic properties are 
much less marked than those of the latter drug, it can be safely used 
in stronger mixtures, and therefore, for practical purposes, its strength 
is greater. 

Kreolin, though insoluble in water, readily forms an emulsion quite 
as efficacious in its antiseptic properties as a true solution. Since this 
emulsion is opaque, it is scarcely applicable for immersing and steril- 
izing instruments, the latter not being readily found. It is admirably 
suited, however, for cleansing the hands, a 5 per cent, solution neither 
cracking the skin nor benumbing the sensory nerves. In irrigating 
large wounds, cavities of the body, and particularly as a means of 
preventing sepsis or aborting it in gynaecological work, kreolin can be 
warmly commended. It may be employed in a strength of from 0.2 
to 5 per cent. 

Among the many antiseptic agents of less importance may be men- 
tioned Peroxide of Hydrogen. This drug comes in what is termed a 
ten-volume solution. By this it is meant that ten volumes of feebly 
combined oxygen are contained in each volume of the liquid. It is 
applicable, not to sterile surfaces, but to suppurating wounds and 
sinuses. It is alleged that peroxide of hydrogen immediately destroys 
the micro-organisms of pus. converting, in one or two applications, a 
septic wound into one which is sterile and which will promptly heal. 
It is used in the strength of from 5 per cent, up to full concentration. 
Its disadvantages lie in the fact that it is expensive, that from acidity 
it is often irritating, and that it readily undergoes decomposition. In 
this latter circumstance, possibly, lies the explanation of its want of 
popularity, since the preparations vary so greatly in strength that it is 
impossible to determine to what extent they should be diluted or what 
may be their potency when applied. When this drug is poured into a 
suppurating sinus or cavity an ebullition takes place, which ceases only 
when the drug is exhausted or the dead material has been oxidized. 
Chloride of Zinc has been extensively employed in some clinics as 
an antiseptic application. It is used in 10 per cent, solutions, and is 
applied when the field of operation is probably infected by pre-exist- 
ing pus-formation. Although bacteriological research has shown that 
this agent possesses feeble antiseptic power, clinical experience dem- 
onstrate its value when applied to infected surfaces. Lately the 
Sulpho-carbolate of Zinc has to a great extent replaced the chloride, as 
it is less toxic and irritating and far more potent. 

For the sterilization of mucous surfaces a saturated aqueous solu- 
tion of Boric Add is commonly employed. More potent than this 



ANTITOXIN. 439 

are the silver salts, nargol, protargol, and silver nitrate in solutions of 
1 : 2000 to 1 : 1000. 

An omission of the details of cleansing the hands of the surgeon 
and assistants in preparing for an antiseptic operation is scarcely 
permissible in writing upon the subject of antisepsis. The most 
approved method is as follows : 

The hands and forearms are thoroughly brushed in hot soap-suds 
for ten minutes, after which the nails are carefully cleaned by a knife 
and brush, and the washing repeated ; the hands are then washed 
in alcohol for one minute, special attention being paid to the nails; 
finally they are soaked for one minute in a solution of bichloride 
(1 : 1000), and during the course of the operation are occasionally 
washed in a solution of one-half this strength. If it is necessary to 
lift a chair, to turn the patient, or to touch any object which has not 
been previously sterilized, the hands should be enveloped in towels 
wrung out in 1 : 1000 solution or immediately washed again. Another 
method which has been found by Kelly to be the best, bacteriologically 
and practically, is to cleanse the hands and nails by scrubbing with 
hot water and soap, and then to immerse the hands and arms in a 
saturated solution of permanganate of potassium made with hot water. 
After this the skin is decolorized by immersion in a saturated solution 
of oxalic acid. Finally, the oxalic acid is washed off with hot steril- 
ized water. 

Any method which irritates or cracks the skin of the hands is 
dangerous. The only certain way of avoiding infection from the hands 
of the operator lies in the use of rubber gloves. 

ANTITOXIN. 

Before we study this method of treatment, let us understand the 
basis upon which it rests. It being universally admitted that the 
bacillus of diphtheria, by its local growth, produces toxins which, 
when carried in the blood or lymphatics, destroy the functional and 
organic life of the vital tissues, it is at once evident that in the 
body of the patient there must be two processes looking toward its 
own protection. The first is the effort at elimination on the part of 
the emunctories ; the second is a hypothetical process — namely, that 
the tissues and liquids of the body contain, or at once manufacture, 
an antitoxin, the effects of which are directly antagonistic to the 
toxin of the disease. Although vital resistance consists in far 
more than this simple and single method of defence, it suffices at 
present to discuss only this part of it. If the tissues can form enough 
antitoxin to protect the organism, the patient recovers ; if they fail, 
either because they are feeble or because the dose of the toxin is 
overwhelming, the patient dies. In the case of diseases, such as 
scarlet fev.er and small-pox, w T hich rarely attack the same person 
twice, it perhaps may be said that immunity is conferred by the 
tissues being trained or educated, as it were, to prepare antitoxin 
in such large amounts when called upon that the entering wedge of 



440 REMEDIAL MEASURES OTHER THAN DRUGS. 

a new attack is snapped off at the moment it begins to enter the 
field. While we rest this view of the case upon hypothesis, it fur- 
nishes us with a result which enables us to base the new treatment 
upon rational lines : and it would seem probable that the ability to de- 
velop large amounts of antitoxin possessed by certain animals, added 
to other defensive processes, renders them practically entirely immune 
from an attack of a disease at any time. Thus, the goat and horse 
are by nature practically immune to diphtheria, while the guinea-pig, 
on the other hand, is peculiarly susceptible. Supposing the horse 
and goat to be naturally able to resist diphtheria-inoculation to the 
extent of almost complete immunity, it becomes necessary, in order 
to make the resistance of their blood-serum absolute, to stimulate, if 
we can use such a term, their antitoxin-preparing powers, and with 
this object in view injections of the toxin derived from cultures of 
diphtheria germs are made into the blood of the naturally immune 
brute. As a result, the serum of the blood of the animal possesses the 
power not only of resisting diphtheria poison while in its own vessels, 
but confers immunity of a temporary kind upon any other animal 
into whose body some of it is injected. It has been found experi- 
mentally that antitoxic horse-serum when injected into the susceptible 
guinea-pig renders that animal to a great extent insusceptible to inocu- 
lation by diphtheria. This is a very brief but perhaps sufficiently long 
explanation of the rationale of antitoxin treatment, which opens itself 
like a beautiful fan over many other diseases than the one we are dis- 
cussing. 

Antitoxin for Diphtheria. 

While all of the antitoxins seem theoretically to promise well, in 
practice we find that only one is absolutely reliable, and it has 
received general recognition. This one is the antitoxin of diphthe- 
ria. The following process is followed in its preparation : a pure 
culture of the bacillus of this disease having been grown, colonies of 
the bacillus are picked up off the culture gelatin and placed in tubes 
of blood-serum, which in turn are placed in an incubator until the 
bacillus has developed its full virulency, when flasks of bouillon are 
inoculated by the germs. These flasks are placed in an incubator, 
where there is rapidly produced the diphtheritic poison in the bouillon. 
After a length of time sufficient for the development of the poison 
the fluid has added to it a small amount of some preservative, and is 
then filtered through unglazed porcelain, whereby all the bacilli and 
other particles are separated, the filtrate being a clear straw-colored 
fluid. This is the fluid containing the toxin. The toxin of each flask 
varies in its power, so it is necessary to determine its activity. This 
is done by injecting it into guinea-pigs, which animals are very sus- 
ceptible. Usually from 2 to 100 milligrammes are required to cause 
dentil within a few days. A young, healthy horse now receives 
about 1.0 cc. of the toxin by injection into a vein ; that is, ten times 
the fatal dose for the guinea-pig, provided the fatal dose was 0.1. 
Horses are chosen because thev are naturally immune, have large 
amounts of blood-serum, and are easily handled. Gradually increas- 



ANTITOXIN. 441 

ing doses are given until the horse can readily receive several hun- 
dred times the first dose without any ill effects. The horse is now 
capable of rendering antitoxic serum, and he is bled. The blood- 
serum is separated and purified and is then tested to determine its 
power. Ten times the smallest fatal dose of toxin is now injected 
into a guinea-pig, and at the same time 0.1 cc. of the horse's serum 
is injected. If the guinea-pig survives, the serum is said to contain 
a unit of antitoxic power in each cubic centimetre, and as the dose 
given was only one-tenth of a cubic centimetre it follows that each 
cubic centimetre is ten times the amount of serum sufficient to protect 
a guinea-pig from ten times a fatal dose of toxin. If this strength 
of serum were used, very large doses would have to be given to get 
any effect in man, so we are not satisfied with this result, and by 
continued dosing of the horse we may obtain, from his blood, serum 
which will be active in protecting the guinea-pig, not in the dose of 
0.1 cc, but in the dose of 0.001. Such a serum contains therefore 
100 antitoxin units to the cubic centimetre. A dose of 5 cubic 
centimetres of this strength would therefore give 500 antitoxin units. 
Even this is not satisfactory, so most of the serum on the market is 
so strong as to contain from 200 to 300 or even 1750 antitoxin units 
in each cubic centimetre, so that 2 cc. of the latter would be a dose 
of 3500 units. These very high potency serums lose their efficacy if 
kept for any length of time, and are therefore not as reliable as the 
lower potencies unless they are fresh. All serum of whatever strength 
should be obtained as fresh as possible. 

Antidiphtheritic serum has been used with asserted great success 
in cases of typhoid fever and in asthma. Under these circumstances 
it does not exercise any specific effect, but is supposed to act by 
increasing leucocytosis and aiding in the elimination of poisons. 
McCalluna states that its use improves the action of the heart and 
the tone of the vessels. 

The use of antitoxin in diphtheria will be found discussed under 
that disease. (See Diphtheria.) 

Antitoxic serum has been used in tetanus and many other infec- 
tions. In none of them has it given results which render it equal in 
value w T ith that used for diphtheria. The same statements hold true 
in regard to anti-pneumococcic and anti-tubercular serums. 

Antistreptococcic Serum. 

As is well known, infection by the streptococcus produces the 
more severe forms of septicaemia as met with in the puerperium, after 
injuries and operations, in erysipelas, and in association with such 
specific infectious processes as scarlet fever and diphtheria. In the 
latter diseases under these circumstances there is, of course, a double 
infection. While the theoretical basis upon w T hich the use of this 
serum rests is quite as good as that of antitoxic serum for diphtheria, 
the results from its use have not been so valuable, probably because 
in many instances the infectious process has not been purely due to this 
micro-organism and the other disease organisms have produced their 



442 REMEDIAL MEASURES OTHER THAN DRUGS. 

effects uninfluenced by the serum used. The best results have been 
obtained from its use in 'puerperal and post-traumatic sepsis, but only 
in the presence of well-marked and positive streptococcic infection 
would the writer resort to it. Its method of employment is identical 
with that of diphtheria antitoxin. Care should be taken to obtain 
the serum from a reliable manufacturer. It would seem probable 
that in some cases of infectious endocarditis this serum is the best 
treatment we can use, and in many cases of puerperal infection it may 
be tried with advantage. The dose of this serum is usually 10 to 20 
cubic centimetres every twelve hours according to the age of the patient 
and the severity of the infection. 

CLIMATIC TREATMENT. 
(See Springs and Climates.) 

COLD AS A REMEDY. 

Cold, or the rapid abstraction of heat, is a remedial measure that 
can nearly always be obtained, and is possessed of very great power 
for good in properly selected cases. At the very first we may divide 
its use into its local application, for a superficial limited, deep-seated, 
or distant influence, and its general application for the purpose of 
affecting the entire body. 

When cold is applied for its limited and local action it is always 
used with two objects in view — namely, to cause localized contraction 
of blood-vessels which through inflammation are engorged so that the 
parts are reddened and swollen, or temporarily to anaesthetize or 
benumb a nerve-fibre for the immediate relief of pain, and with the 
hope that the temporary paralysis may ultimately result in such nerve- 
changes as to produce a cure. 

For these reasons cold, in some form, is a popular remedy for a 
burn or sprain or any injury likely to be followed by inflammatory 
processes. In some cases, it is true, hot water or dry heat is equally 
efficacious, and this fact will be referred to again when speaking of 
heat. (See Heat.) It may, however, be stated, as an almost invaria- 
ble rule, that the choice of heat or cold is to be governed by the sen- 
sations of the patient, who will generally assert that one of the two 
is the more agreeable. 

Cold or heat causes relief of pain in inflammation by producing 
contraction of the local blood-vessel walls. As a result, inflammatory 
exudates do not occur, congestion is relieved, and as the pressure on the 
nerve-filaments ceases the pulsating pain of inflammation passes away. 

A very useful remedy for the sprain of an ankle when it is a recent 
accident is to let the patient sit with the foot elevated, with a cloth 
wrung out in ice-water or an ice-bag applied over the part affected. 

In the treatment of localized pain or inflammation cold is used in 
a number of ways, largely depending in their choice on the will of 
the physician and the means of the patient. The simplest, cheapest, 
and perhaps the most efficient method of using cold is to place cracked 
ice in a pigs or sheep's bladder or rubber bag, and, after tying the 



COLD AS A REMEDY. 443 

opening to prevent leakage, to lay it over the inflamed part, sur- 
rounding it with a towel, so as to prevent the moisture, which appears 
on the surface from condensation, from wetting the clothing. 

Where a very limited and comparatively transient effect is needed, 
chiefly for anaesthetic purposes, it is customary in hospital and private 
practice to use a piece of ice sprinkled with a little fine salt, and held 
against the skin by means of a towel in the hands of the physician. 
Actual freezing can often be produced very rapidly in this manner. 
Where a more rapid method is desired, sprays of various very volatile 
liquids may be driven against the part by an atomizer. Probably the 
most readily employed of these liquids is ether, which is fairly effective 
if it is used in a fine spray and driven against the skin in such a way 
as to favor rapid evaporation. Another of these agents is rhigolene, 
which is one of the lightest and most volatile of the liquid products of 
coal-tar, and is used in a spray from an atomizer in the same manner as 
is ether. Chloride of methyl is a liquid of a sweetish smell and taste, 
used as a substitute for rhigolene as a local anaesthetic through the 
intense cold produced by its evaporation. The fluid is directed against 
the skin over the involved area by means of a nozzle attached to the 
cylinder containing it. (See Ethyl and Methyl Chloride.) 

It is hardly necessary for the writer to repeat that, as the last three 
liquids are very inflammable, they should not be used near a light or 
fire. 

Aside from the local effects of cold on inflammatory processes, it is 
largely resorted to for the relief of neuralgia of a superficial type, 
and has often been used for the cure of deep-seated neuralgias, as over 
the course of the sciatic nerve in sciatica. Generally, however, it is 
employed in neuralgia of the supraorbital nerve, where, owing to the 
superficial position of these fibres, the cold can readily reach them. 
The skin should be distinctly whitened and blanched, and even hard- 
ened, by the cold before its application is stopped, and if one applica- 
tion does not cause a cure, it may be repeated every day for several 
weeks in obstinate cases. Sometimes cold is used to benumb the skin 
or subcutaneous tissues in cases where a minor surgical operation is to 
be performed, and it is undoubtedly superior to cocaine where one 
wishes to open boils or small abscesses. It is also valuable when the 
physician is using the actual cautery, and in all these cases may be 
employed as is indicated above. 

The local employment of cold for the influencing of deeply-seated 
organs is a well-recognized therapeutic measure of great practical and 
physiological interest, and is closely associated with the subject of 
counter-irritation. (See Counter-irritation.) According to Winter- 
nitz, cold applied to the feet affects the cerebral circulation, cold to 
the thighs the circulation in the lungs, and cold to the back the cir- 
culation around about the pituitary region. That these conclusions 
are true we do not positively know, but the fact that Winternitz has 
reached them by a series of experimental studies indicates their cor- 
rectness to a great extent, and they also find additional support in 
the popular and medical confidence in the use of cold to the head and 
heat to the feet in cerebral affections. 



444 REMEDIAL MEASURES OTHER THAN DRUGS. 

Practically, cold has been employed with no small degree of suc- 
cess in the treatment of pneumonia and pleurisy in the form of the 
ice-poultice or ice-jacket or the ice-coil. (Fig. 54.) The only thing 
needful for such treatment is a condition of strength on the part of 
the patient, for it should not be used in adynamic cases, as feeble 
patients cannot stand the abstraction of so much heat from their 
bodies. When the ice-poultice is used, it is made by taking a mass 
of finely chopped ice, draining it of all water, and mixing it thor- 
oughly with dry sawdust in sufficient quantity to absorb all the 
water derived from the ice as it melts. This is then basted into a 
quilt, so arranged that all of the contents will not sag to the lower 
border, and wrapped around the chest, the mass being thoroughly 
covered by a layer of well-oiled silk. Cold has also been highly 

Fig. 54. 




Showing the application of the cold-water coil to the chest in croupous pneumonia or pleurisy. 
Applied to the left side, it may be so used in pericarditis in place of the ice-bag. By suc- 
tion on the lower end of the tubing a stream of water flows from one bucket to the other, 
and when the water has been transferred the stream may be reversed by changing the level 
of the buckets. 

recommended when used in pneumonia in another manner, and by no 
less an authority than Niemeyer, who speaks of it as follows : 

" I have made extensive employment of cold in the treatment of 
pneumonia, and, relying upon a large number of very favorable 
results, can recommend this procedure. In all cases I cover the chest 
of the patient, and the affected side in particular, with cloths which 
have been dipped in cold water and wrung out. The compresses 
must be reapplied every five minutes. Unpleasant as this procedure 
is id almost all cases, yet even after a few hours the patients assure 
me that they feel a material relief. The pain, the dyspncea, and often 
the frequency of the pulse are reduced. Sometimes the temperature 
goes down an entire degree. My patients often retain this surpris- 
ing condition of improvement throughout the entire duration of the 
attack, so thai their outward symptoms would hardly lead one to 
imagine the grave internal disorder. The relatives of the patient, 
too, who do not fail to perceive the improvement, now readily assist 



COLD AS A REMEDY. 



445 



in the treatment to which at first they were opposed. In a few cases, 
and only in a few, the use of cold affords no relief, and the trouble- 
some manipulation for its application increases the distress of the suf- 
ferers so much that they refuse to keep it up. In such cases I have 
not insisted upon the further application of cold." 
- In endocarditis, and especially in pericarditis, do we find an ice- 
bag placed over the heart a valuable remedial procedure, for it relieves 
palpitation and quiets the heart, decreases the pain and diminishes 
the inflammation. It is also useful for cardiac palpitation and for 
the rapidly acting heart of fever during the course of pneumonia or 
typhoid fever. 

Cold effusions to the head, and, better still, the use of an ice-bag, 
have long held a high position in the treatment of meningitis and head 
injuries, and a hot bottle to the feet and cold to the head will often 
cause sleep in persons who habitually suffer from insomnia. This is 
particularly the case with those persons who have wakefulness from 
mental overwork. On the other hand, cases with insomnia from 
cerebral anaemia do well if a cold plunge-bath is taken before going 
to bed, although in still other cases a hot bath is more efficacious. 
(See Heat.) The latter instances are not due to anaemia, but to ner- 
vous irritability, which the heat quiets, whereas the insomnia of cere- 
bral anaemia is relieved by a cold plunge by reason of the increased 



Fig. 55. 




Showing the application of the cold-water coil to the head in cerebral congestion, headache, 

meningitis, and in fevers. 

circulatory activity and equal distribution of the blood produced by 
the bath. (Fig. 54.) 

When cold is to be applied to the head continuously, it is often 
convenient to employ a coil made of rubber tubing and so shaped as 
to fit the vertex. One end of the tubing should reach to a tub of 
cold water on one side of the bed and the other to an empty tub on 
the other side. By sucking on one tube siphonage is established, 
and as soon as the liquid has been transferred from one tub, the 



446 REMEDIAL MEASURES OTHER THAN DRUGS. 

full bucket is raised, the stream is reversed, and the water passes back 
again to its former receptacle. 

Cold water dashed or sopped against the perineum or the scrotum 
and the lumbar region is a favorite remedy for nocturnal seminal 
emissions with some practitioners, and the scrotum may be submerged 
in a tumbler of cold water for a few minutes at night for a similar 
purpose. 

A very useful treatment of dysentery is to gently inject into the 
rectum about one or two quarts of cold water — if necessary it may be 
icy cold ; and a similar application for piles is a useful adjunct to all 
forms of treatment for these troublesome formations. 

So highly do some physicians praise this method that the writer 
has thought it proper to quote from a paper of Dr. J. William White 
upon this subject. He says: 

" I desire to call the attention of the profession to a method of 
treatment which, although not altogether new, is yet not appreciated 
as, in my judgment, it should be. I refer to a moderately forcible 
stream of water of varying temperature in the treatment of a number 
of affections of the rectum, anus, and genito-urinary apparatus. The 
tonic and astringent effect of such a stream of water upon any living 
tissue is, of course, a well-understood fact, and has been employed in 
the arrest of hemorrhage, in the treatment of inflammation, and in 
various conditions. But it has only been in exceptional cases, and 
usually by the aid of more or less troublesome apparatus, that it has 
been used in the class of cases to which I now refer. 

" The bidet, as I have now for a few years prescribed it, should be 
of the variety which can be attached to the water-closet seat habit- 
ually used by the patient. It should have a nozzle capable of throw- 
ing a stream of about the calibre of an ordinary lead-pencil or a lit- 
tle less. The head of water should be sufficient to make it impinge 
upon the parts exposed to it with enough force to excite there a little 
sensation of smarting or tingling. That degree of force will, for 
example, be sufficient to enable the patient to take an enema, or, if a 
female, to take a vaginal injection. The bidet pipe should be mov- 
able by means of a handle, so that the stream can be directed against 
any portion of the external genitals, the perineum, the anus, or the 
surrounding parts. It should also have connection with the hot and 
cold water-supply of the house, so that the water may be used of any 
temperature which the physician may prescribe or which the sensa- 
tions of the patient may make desirable. Stopcocks should regulate 
the size and force of the stream, and should be so placed as to be 
easily reached by the hand of the individual sitting upon the water- 
closet seat. Such an apparatus can be put in place by any experienced 
plumber in any ordinary water-closet at an expense of from fifteen to 
twenty dollars, and, in Philadelphia at least, the usual head of water 
obtainable even in third-story rooms is quite sufficient for all thera- 
peutic purposes. 

"The diseases in which it may be desirable to use this method of 
treatment may be divided into two classes: First, those affecting the 
lower end of the bowel and its outlet; second, those involving the 



COLD AS A REMEDY. 447 

genitourinary system. Among the first the most important are hem- 
orrhoids, internal and external, prolapsus ani, and slight cases of 
prolapsus recti; pruritus ani and eczema of the margin of the anus 
should also be included in this group of cases, in which it has now 
for some time been my habit to prescribe the systematic employment, 
twice daily, of the bidet, one immediately after the daily stool, and 
for the second time, by preference, just before going to bed. As a 
rule, in all the midwinter months the ordinary temperature of the 
Schuylkill water is that to be preferred, although I am largely gov- 
erned by the feelings of the patient in this respect. An enema 
should be taken at each of these times, the lower portion of the rec- 
tum being thus thoroughly washed out at least twice daily, after 
which the stream of water is allowed to play upon the affected region 
for a period of from five to fifteen minutes. The ordinary and useful 
effect of cool sponging or washing immediately after stool in cases 
of hemorrhoids is by this means enormously increased. Internal 
hemorrhoids will,- under this treatment, in many cases almost 
entirely disappear, unless they are exceedingly large and have 
been frequently inflamed or strangulated and badly neglected ; 
external hemorrhoids, even when fleshy, will shrivel and become 
scarcely noticeable. 

" I could detail a number of cases of this character taken from my 
practice of the last two years. In some instances in which I had been 
habitually called in, at intervals of a few months, in the case of old 
people, the result has been practically their disappearance from my 
list of patients ; and they speak in the warmest manner of the great 
comfort derived from this simple method of treatment. 

" Perhaps nothing is more distressing among minor affections than 
the trouble described as pruritus ani, and variously attributed to liver 
disease, constipation, gastric troubles, latent gout, uterine disease, 
parasites, neuroses, and a number of other causes, varying from eat- 
ing of shell-fish or excessive smoking to alleged hereditary predis- 
position. There are very few practitioners of any experience who 
have not discovered how difficult it is in any particular case of pru- 
ritus to assign distinctly the annoying symptoms to any one of these 
causes. Often the whole list may be carefully gone through and 
eliminated, or the proper remedies may be applied successively, as 
different theories are adopted, without the slightest benefit resulting. 
Ointments, lotions, and ordinary cool bathing will be tried in great 
variety, but without avail, and such patients will often go from one 
physician to another or fall into the hands of quacks while seeking, 
proper professional relief. My list of cases of this character which 
I have now treated by means of the ' bidet ' comprises eight. 

" Nearly all my cases have resulted in cure, requiring to attain 
that end simply different lengths of time of the application of the 
douche, with variations of the temperature of the water and occasion- 
ally the use of some emollient salve. I have been particularly struck 
by the fact that these cases include among their supposed causes 
widely distinct conditions, and the uniformity with which they have 
yielded to this simple treatment has led me to regard with suspicion 



448 REMEDIAL MEASURES OTHER THAN DRUGS. 

the orthodox etiology of the disease. In procidentia ani and in slight 
cases of prolapsus recti I have had very satisfactory, though of course 
less striking, results. In a few instances the trouble almost entirely 
disappeared, and in all of them it was distinctly relieved. These cases 
require for their successful treatment a much longer application of the 
douche, and the water should, in my judgment, be at one or the other 
extreme of temperature — either quite cool or as hot as can be com- 
fortably borne. 

" I am quite aware that the use of cold water in these affections is 
not in the least a novel plan of treatment ; but the method under 
consideration combines the effects of temperature with a sufficient 
force of the stream, and admits of the prolonged application of the 
remedy without effort on the part of the patient, who is in the most 
suitable position for this treatment — practical points which induced 
me to make this mention of my results in rectal and anal cases. 

" Agnew says of pruritus that among the local remedies frequent 
ablutions with cold water should be mentioned, and of prolapsus ani 
et recti that ' in all cases where remedies have proved unavailing, or 
where patients have declined an operation, much good may be done 
by douching the parts with cold water and applying an oiled com- 
press;' and Allingham says of the same class of cases that 'the fre- 
quent and bountiful application of cold water is to be most strongly 
recommended ;' but few authors, so far as I know, have especially 
alluded to the method of application by means of a bidet. 

"My second class of cases includes, chiefly, certain prostatic 
troubles, varicocele, atonic impotence in the male, and pruritus of 
the vulva or vaginitis in the female. In case of variocele, although 
I have not succeeded in effecting a cure in any instance by this 
method, I have certainly seen advancing enlargements of the sper- 
matic veins becoming stationary, long relaxed and pendulous scro- 
tums become firm and much smaller, and the mental condition of the 
patient, which is so important an element in many of these cases, 
shares in the improvement. In chronic prostatitis, a most intractable 
and distressing ailment in many instances, it has come to be a part 
of my routine treatment to order the use of cold perineal douches by 
means of the bidet, associated with frequent cold enemata given in 
the same manner ; and I believe to-day that if I had to discard all 
therapeutic measures but one in these cases, I would retain this one. 
In a certain number of cases of impotence associated with general 
muscular weakness, loss of tone, lack of general strength and vitality, 
accompanied by imperfect or rapidly-subsiding erections, I have found 
that the cold douche applied with some force and for considerable 
lengths of time to the perineum and testicles has been productive of 
marked benefit. 

" In two cases of pruritus vulv;e my results have been good, 
though Less striking than in similar disease affecting the region of the 
anus. In vaginitis, where the woman has sufficient intelligence to 
learn how to take an injection by means of the bidet, it offers an 
admirable method of cleansing the vagina, of carrying away thor- 
oughly all accumulated secretions, of reducing heat and swelling, and 



GOLD AS A REMEDY. 449 

at the same time of avoiding the frequent introduction into the 
inflamed canal of a foreign body in the shape of the nozzle of a 
syringe. My opportunities for observation in this class of cases have 
been limited, owing to the disinclination of these patients to procure 
the bidet, and owing to their irregular habits of life and their fre- 
quent changes of residence ; but I have seen enough of its good 
results to make me feel confident that it is a valuable addition to our 
therapeutic agencies. 

The use of a cold bath for the purpose of increasing the tone of 
the system is as old a custom as any which we have, but, like all other 
things in medicine, cannot be used without distinct indications for its 
employment, or, to speak more correctly, the absence of certain con- 
traindications. The most universal exception to its use which we find 
is that class of persons with whom prolonged bathing of any kind, par- 
ticularly when it is frequently repeated, does not agree. The writer 
is sure that a much larger number of persons belong to this class than 
is generally recognized, and he has seen cases of nervous exhaustion 
and general loss of vivacity and vitality occur as a result of too fre- 
quent bathing. This is the case more especially with daily bathers 
who soak themselves in hot or warm fresh water, particularly if the 
bath be taken in the morning. 

Before passing on to a consideration of the physiological action 
of a bath, and why and when we should use it, it is proper to call 
attention to the fact that a very large proportion of children who are 
bathed daily are allowed to lie and soak in the tub, and as a result 
become debilitated and fretful, only to recover when the bath is used 
once or twice a week, and replaced in the interval by a nightly spong- 
ing off with salt and whiskey or salt and water. 

Through practical experience and much experimental research of 
a reliable character we now know that the following phenomena 
accompany the use of a cold bath in a healthy person with whom 
such a bath agrees : 

On entering the water he shivers, thinks it almost unbearably 
cold, and he gasps if the cold suddenly touches the belly-wall or an 
equally sensitive surface. In a moment, however, reaction sets in, 
and the extremities, heretofore trembling and covered with cutis 
anserina, become warmer and flushed. The pulse is increased in 
force and frequency, and the respirations are deeper and more thor- 
oughly performed. As a result of this each portion of the body 
receives a more perfect supply of blood and feels rejuvenated. Fol- 
lowing this stage of exhilaration, a third comes on, in which the 
chilliness and depression of the first stage recur in an exaggerated 
degree, but this condition does not ensue unless the person remains 
too long in the water. If he leaves the bath while in the acme of 
his exhilaration, the stimulus may remain with him throughout the 
rest of the day. 

The reason for the occurrence of this train of symptoms is not far 
to seek. The chilliness of the first stage shows that the great abstrac- 
tion of heat is lowering the bodily temperature, the centres for calori- 
fication in the body not manufacturing all the heat that is needed for 

29 



450 REMEDIAL MEASURES OTHER THAN DRUGS. 

the preservation of the normal temperature. At first the cold drives 
the blood hurrying into the warm recesses of the body, leaving the 
surface of the body cold ; but in a few moments the system is aroused 
to the recognition of the fact that it must increase its exertions in 
the propulsion of blood and manufacture of heat, and so, with an 
effort it puts forth all its power, picks up each corpuscle that is hiding 
from the cold in the internal organs, and, after imbuing it with warmth 
obtained by increased heat-production in the sources of heat-manu- 
facture, forces it out to the surface of the body along with its fel- 
lows, which are driven to all parts of the system. This is not a 
mere figurative way of putting the matter, for cold always contracts 
blood-vessels and reflexly stimulates the vital centres to increased 
activity. 

When the bath is too prolonged the result of over-stimulation 
ensues, and the depression of the nervous system and circulation 
may be sufficiently severe to interfere greatly with normal functional 
activity. 

Just at this point it becomes clear why persons 4t catch cold,'' or, 
technically speaking, are attacked by local or general congestions. 
A person who is weak may never reach the stage of stimulation 
just spoken of, because his system has not enough units of force in 
it to expend them upon the functional activities named, and. as a 
consequence, the blood, which at the first shock has hurried into the 
internal viscera, is not driven back to its duty, but, sulking in its 
retreat like a deserting soldier, allows disaster and disease to ensue 
because its superior officer, the central nervous system, cannot gather 
together enough force or authority to make it do its duty. These 
cases present evidences, therefore, of circulatory and systemic de- 
pression or have congestion of the lungs, liver, or other parts. In 
the strong person exactly the same state of affairs obtains in the 
third stage of depression, but only after the strength of the system 
has been expended in the activity of the stage of exhilaration. 

Cold salt baths, particularly if they are sea baths, are more stimu- 
lating and not so relaxing as is fresh-water bathing. 

The use of a cold bath after a person becomes heated is popularly 
supposed to be dangerous. On the contrary, every athlete knows 
that nothing is so refreshing and so preventive of muscular stiffness 
after severe exercise and sweating as a cold plunge- or shower-bath ; 
but he also recognizes the fact that a plunge is all that is permissible, 
and it is only the person who possesses the healthy circulatory power 
which will enable him to rebound from momentary depression to 
increased activity that should resort to such procedures. 

The tonic effect of the so-called drip-sheet in certain neurasthenic 
cases is most marked. As has been pointed out. reaction must he pro- 
duced, since it is by the stimulation of the circulation and its readjust- 
ment or equalization that good is achieved. The duration of the use of 
the drip sheel and the temperature of the water in which it is wrung 
out are governed by the ability of the patienl to react. Very feeble 
patients must be gradually trained by moderate means to the colder 
temperatures, and. if need be, may stand in a tub containing a few 



COLD AS A REMEDY. 



451 



inches of warm water if there is a tendency to coldness of the feet. 
The patient being stripped, the nurse takes a linen sheet previously 
wrung out of water at any temperature that is not too low for reaction 
to take place, and throws it around the patient's figure and over the 
head, so that in a moment the entire surface is in contact with it. 
Then the nurse applies brisk friction on the back of the patient's body 
and limbs, while the latter rubs the front of the body with his own 




Drip-sheet wrung out and thrown about the patient, who rubs himself in front while the 
attendant applies friction to the back of the body and limbs. 

hands. The whole performance is over in a few moments, and the 
patient may then lie down, be lightly covered, and rest. Such a drip- 
sheet will often be a cure for insomnia depending upon faulty cerebral 
circulation or nervous tension. In other instances it seems to be stimu- 
lating, and to wake up dormant functions. Once a day is usually often 
enough to use it, and when treating neurasthenics the morning is the 
best time to employ it unless it is designed to cause sleep. (Fig. 56.) 



452 REMEDIAL MEASURES OTHER THAN DRUGS. 

Cold in Fevers. 

The proper manner to employ cold water in fever should be thor- 
oughly understood. It may be used at a number of temperatures, 
according to the effect desired, such as cool, moderately cold, and 
very cold. 

Very commonly in the course of a fever the patient is restless, 
uncomfortable, and sleepless, yet has not a temperature fraught with 
any harm. Such a case may be sponged off with tepid water or with 
a little alcohol and water, or salt and whiskey, with great benefit in the 
production of sleep, the reduction of fever, and the advantage of ner- 
vous quiet. Sometimes the sponging is successful when used only 
over the arms and legs, but more frequently it should be extended at 
least to the spinal column. 

If tepid sponging does not lower the fever in a given case, then 
ordinary cool tap-water should be employed ; and it is well to remem- 
ber that the secret of successful sponging lies in the- use of a sponge 
not saturated to overflowing, but only sufficiently wet to leave a thin 
film of moisture on the skin, which cools the patient by its rapid 
evaporation and does not wet the clothes and the bed. 

When we come to a study of the use of cold water in prolonged 
and severe fevers we find that its use is now universally recognized 
as the proper treatment, and with good reason. At one time it was 
thought that all the good results from cold bathing were due to the 
reduction of the fever, but we noAV know that this is the least im- 
portant effect of the bath except when there is such a hyperpyrexia 
that there is danger from that source. The benefit derived from the 
external use of cold water in infectious fevers rests upon the stimula- 
tion of the vasomotor system and general circulation, so that local 
stasis or congestions of blood do not occur in vital Organs, in the 
stimulation of the processes of oxidation and nutrition, and in the 
elimination from the body by the skin and kidneys of toxic materials. 
Further, the more frequent cleansing of the skin aids its normal func- 
tion, prevents chafing and bed-sores, and lowers the temperature by 
aiding in the dissipation of heat directly and through the sweat, which, 
even if imperceptible, is an important factor in reducing body-heat. 

Whenever cold is used for the reduction of fever and applied to 
the entire body it should be applied rapidly and be accompanied by 
active rubbing of the skin of the entire body to bring the hot blood 
to the surface and to gain the valued effects of massage. As a rule, 
the water should be used at one temperature, and better results will 
be obtained if it is cold enough to produce something of a shock to 
the circulation and nervous system, for the effect sought is the pro- 
duction of a " reaction" — that is, a redistribution of the blood and 
an awakening of all the vital processes. For this reason the writer 
does not approve of graduated baths — that is, the use of water which 
is gradually cooled while the patient is being bathed. The whole 
idea of the cold-bath treatment of fever is to produce the reactive 
stimulating effect sought by the well man who takes a sea bath. 
For this reason persons too feeble to react should be bathed in 
slightly cooled water at first, and the temperature reduced each day 



COLD AS A REMEDY. 453 

a few degrees until it is quite cold. The exact degree of cold 
depends upon the need of the patient as stated below. 

Fever is then to be reduced by the cool sponging, in old and 
feeble patients using water at 90°, 80°, or 70°, according to the 
ability to react and the needs of the patient. Friction is to be used 
with one hand while the sponging is done with the other. 

If the patient is young enough and sufficiently strong to react, then 
the water used should be from 70° to 32°, according to the needs of 
the case ; and if the fever is persistent and difficult of reduction, the 
nurse may use a piece of ice rubbed over the skin rapidly, rubbing 
constantly with the other hand. 

The patient should always be stripped and laid on a blanket 
spread over a rubber sheet which has been placed to protect the bed. 

It is essential when the sponging is used that more of it be applied 
to the back than the front of the body, for at the back the great 
muscles and thick skin retain the heat, and these parts are not cooled 
if only the front of the body is sponged. Further, the posterior 
surfaces are the ones apt to be congested and sore from the dorsal 
decubitus, and therefore need the stimulant eifect of the bath, as do 
the kidneys and other deeply situated organs. That this treatment 
is of value in those who react is shown by the marked redness of the 
skin, the improvement of the circulation and respiration, and the 
cleared mind. 

If the fever cannot be reduced to 101° by the methods of bathing 
just detailed, the patient should be subjected to the cold plunge or 
tubbing, the so-called " Brand bath," which has been employed almost 
exclusively in typhoid fever. The chief object sought by its use 
has already been described in discussing the effect of sponging. This 
object is reaction. 

The method consists in immersing the patient every three hours, if 
his temperature reaches 102° or 102.5°, in a bath-tub of water at 70° F. 
and allowing him to remain there under friction for fifteen or twenty 
minutes, or until his temperature is reduced to 101° or 100°. Before 
the patient enters the tub he is often given |tol ounce (15.0-30.0) of 
whiskey in a little milk or water to prevent depression. The patient 
will generally complain bitterly of the cold, particularly at first, and 
will also appear blue and chilly after the bath, but these signs are 
not so dangerous as they are alarming. If there be persistent 
and prolonged coldness, then hot bottles may be applied to the 
feet and a little whiskey or brandy given. During all kinds of 
bathing an ice-bag should be kept to the head to prevent cerebral 
congestion. 

When the tub is used, it should always be placed near the patient's 
bed, so as to avoid unnecessary disturbance and mental excitement, for 
his strength must be preserved. 

In using the Brand bath, a patient should be lifted with care and 
gentleness from the bed to the tub. The water in the tub should be 
deep enough to nearly cover his body, and yet not so deep as to float 
him in the tub so that he feels uncertain of his position, and has to 
continually exert himself to keep his head above water. The lifting 



454 



REMEDIAL MEASURES OTHER THAN DRUGS 



of a full-grown man into a tub, unless some mechanical aid is em- 
ployed, requires several assistants, and even when they are present, 
is often a strain not only upon the nurses, particularly if a number 
of patients have to be bathed, but upon the patient as well. It is 
very important that patients should not exhaust themselves by making 
efforts under these circumstances. A number of devices have been 

Fig. 57. 




i 



Bath stretcher. (F. E. Hare.) 



invented for the transfer of the patient from the bed to the bath. 
Probably the simplest and best is that employed by F. E. Hare, of 
Brisbane, Australia, as it is inexpensive, and can be employed by two 
persons unless the patient is unusually heavy. It consists, as shown 
in the following figures, in a perforated board from which the water 



Fig 




The use of F. E. Hare s bath stretcher. First stage. 

readily drains when the patient is lifted from the bath. This board 
has a loose piece at the top, which by resting on the head of the tub 
prevents the patient's face from being immersed. A rubber sheet 
having been placed on the bed by the side of the patient, the board 
is laid on top of it, and the patient is then readily slid by a lateral 
movement on to the board, lifted up, and immersed in the tub. After 



COLD AS A REMEDY. 455 

the bath is over, the board is lifted, with the patient upon it, as high 

Fig. 59. 




Second stage. 



as the edge of the tub, a loose piece of board is slipped transversely 
across the foot of the tub, and on this and on the head of the tub rests 

Fig. 60. 




Third stage. 



the board upon which the patient is lying. In a few moments the 
excess of water drains off into the tub, and the board is then lifted on 



456 



REMEDIAL MEASURES OTHER THAN DRUGS. 



to the patient's bed, which is still protected by the rubber sheet. 
The patient is then slid off from the board on to the bedding and the 
necessary handling is completed. 

When a patient comes under observation as late as the third 
week of typhoid fever, the cold bath is contraindicated, as a 
rule, because the patient does not react, owing to his feebleness. 
If it is used from the beginning of his illness, it may be used all 
through the attack, as the system is then trained to react and is 
rarely so asthenic. Other contraindications to the cold bath are 
intestinal hemorrhage and nephritis. Great cardiac feebleness is 
always a contraindication to it, but pneumonia is thought not to be a 



Fig. 61. 




Fourth stage. 

contraindication. With this view the writer disagrees unless the 
pneumonia be due ro stasis and asthenic congestion. 1 

The fever of enteric fever does not readily yield under the use of the 
bath in the first days of its course, whereas that of other maladies does 
do bo. This is an important differential point. 

All cases of typhoid fever should receive the cleansing and reactive 
effects of sponging and rubbing at least once a day, even if the fever 
is not high enough to need reduction. 

In some cases where sponging is not efficient the patient may 
be placed on a small canvas cot placed by the side of the bed of the 
patient and eovered by a large rubber cloth, which, by being raised 
;it the bead and depressed at the foot, forms a channel for the water. 
Over this, again, is placed an ordinary sheet. The patient, after 

1 For a careful rieumi of the " Real Value of t lie Brand Bath in Typhoid Fever," 
by the author and Dr. ('. A. Holder, see the Therapeutic Gazette, March 15, 1898. 



COLD AS A REMEDY. 457 

being stripped, is laid upon this sheet, which is then folded over him, 
and a fine spray from an ordinary watering-pot for flowers allowed to 
play upon his body from end to end. The temperature of the water 
depends upon the effect required. The bed should be so arranged 
that the water will not remain in puddles under the patient, but drain 
off constantly into a bucket at the foot. The sheet being wet allows 
evaporation to go on, and a rapid fall in the fever results. It is of 
the greatest importance that the attendant lightly but briskly rub the 
patient all over with the hands, so as to bring the blood to the sur- 
face and prevent internal congestions. 

Whenever cold is used in febrile cases a thermometer should be 
placed in the mouth or pushed deeply into the rectum, and the fall in 
the temperature watched. As soon as it reaches 101° or 100° F. the 
bath must cease, lest the fall continue, reaction fail, and collapse ensue. 

On the removal of the patient the surface should be gently dried 
with towels, and the bed-clothing consist of only a sheet, or a sheet 
and one blanket in cold weather. Above all things, it must be remem- 
bered that the patient is not to be wrapped up in a blanket, and not 
only this, but that he must not be placed in a blanket while still in a 
wet sheet. The wet sheet, if surrounded by a blanket, soon places 
the patient in a typical Russian or warm moist bath, calculated to 
raise instead of lower the fever. 

Where sunstroke (thermic fever) is present the patient may have 
ice rubbed over his body or be put directly into a bath-tub of ice- 
water; but in any event the attendants must rub the patient's skin to 
bring the hot blood to the surface and prevent congestions. Cold 
water may also be injected into the bowel in cases where the skin is 
cold but the central temperature very high. (See Enteroclysis.) 

The treatment of rheumatic hyperpyrexia by cold is quite as suit- 
able as is this treatment of other fevers when the hyperpyrexia is so 
excessive as to endanger life. 

Baruch, the apostle of hydrotherapy, has recently expressed some 
views in the following emphatic " Dont's," with Avhich the author most 
heartily agrees : 

Don't bathe with cold water to reduce temperature, but to refresh 
the fever-stricken patient. 

Don't permit cyanosis or chattering of teeth ; — stop. 

Don't stop bathing because patient complains of chilliness, unless 
the teeth chatter. 

Don't raise bath temperature on the latter account ; shorten bath 
and increase friction. 

Don't neglect friction during every cold procedure ; it prevents 
chilling. 

Don't disregard the well-ascertained fact that the Brand bath (of 
Q5° to 70° F. every three hours when awake, with active friction) is 
the ideal bath for typhoid fever only. 

Don't give up cold bathing because the ideal bath is not obtain- 
able ; other procedures are useful. 

Don't use the ice coil to the abdomen ; it has no refreshing effect 
and renders the skin beneath it cyanotic. 



458 



REMEDIAL MEASURES OTHER THAN DRUGS. 



Don't lose sight of the fact that the chief aim of all cold proced- 
ures is reaction. 

CO-ORDINATED MOVEMENTS FOR TREATING LOCO- 
MOTOR ATAXIA AND MYELITIS. 

This plan of treatment is based upon the fact that great improve- 
ment in locomotion on the part of ataxic patients can be produced by 
causing the patient to make certain definite movements, the object of 
which is to re-educate his co-ordinating power. The power of co- 
ordination is lost partly by reason of the disease in the nerves and 
spinal cord, and partly by the physician permitting the patient to 
become bed-ridden, so that his otherwise healthy tissues waste from 
disease. Definite exercises in such cases perhaps train collateral 
nerve-centres and -tracts to do work not usually part of their function. 
In any event, such patients often greatly improve under this procedure, 
as has been proved by a large number of clinicians. 

It is vitally important that the various movements should be made 
slowly and with as great nicety as possible. 

Exercises for the Lower Limbs. — The patient lies on his back on a 
firm couch and slowly lifts his fully extended leg until he touches 
with his toes the finger of an attendant, who holds his hand at a dis- 
tance of from eighteen inches to two feet above the bed. These exer- 
cises should be repeated several times with each leg. 

Next, he completely flexes the leg on the thigh, and then the thigh 
on the abdomen. After this the limb is slowly extended until the 
toe once more touches the finger of the attendant, the leg being ele- 
vated at the same time that it is extended. After making this contact 
the extended limb is slowly lowered till it rests on the bed. 



Fig. 62. 



Showing the pigeon-holes into which the patient puts his heels when training his co-ordina- 
tion and muscle-sense in locomotor ataxia. 



A third exercise consists in having a board made with pigeon-holes 
attached to it, the tops of the pigeon-holes being taken oft". A 
dozen of these holes should be made, and either lettered in the order 
of the alphabet or numbered consecutively. The patient lying on 
hie back, with his heels resting in two of these pigeon-holes, is then 
directed to raise a leg and to lower it so that his right heel will come 
down in the pigeon-hole named by the attendant ; so that if his right 
heel is resting in pigeon-hole 1, it may be placed in pigeon-hole 4; 
and afterward the left heel, which may be resting in pigeon-hole 7, 
i> placed in pigeon-hole <>. It will be readily seen that following 
these directiona trains the co-ordinative faculty. The edges of the 
pigeon-holes should be smooth, and perhaps padded, to prevent the 
heel from being injured by striking against them. 



GO UNTER-IRRITA TION. 459 

The Standing Exercises consist in endeavoring to stand with the 
eyes closed and the feet close together, and in trying to stand on one 
foot with the eyes open or closed. 

Another exercise is to paint a black stripe a foot wide across the 
floor of a room, and to direct the patient to walk along this stripe with 
or without support, being careful to keep his feet within its limits. 
He will usually do better with bare feet than if he has his shoes on. 
In taking this exercise the patient should be directed to bring his 
foot down in the natural position, and not upon the heel, as is so 
commonly done by tabetics ; and also he must not evert his toes too 
much in walking, as is so commonly the habit. As the patient im- 
proves, the stripe upon which he walks may be narrowed. 

The next walking exercise consists in going up and down stairs. 
It is well to build a flight of stairs, consisting of five to six steps, 
with a platform, which is so securely built that there is no danger of 
a fall. A balustrade or railing is put on each side of the steps for 
lateral support, and the patient is then made to ascend and descend 
these steps. Care must be taken that he mounts the successive steps 
by a proper contraction of his quadriceps rather than by pulling him- 
self up by the aid of his hands. Many tabetics simply place the 
leg in a rigid position, and then use their arms to elevate themselves 
to the next step. 

Still another exercise is to place the patient in an arm-chair and 
teach him to lower himself into the chair without touching the arms 
of the chair with his hands. 

It is vitally important that these exercises shall not be continued 
until the patient is unduly fatigued. He must simply be slightly 
tired at the most, and usually a quarter of an hour, twice or thrice a 
day, is a sufficient length of time for the treatment. Exhaustion is 
distinctly harmful under these circumstances. The patient should be 
urged to respond promptly to directions, as alacrity is important in 
training the co-ordinative faculties. 

Somewhat similar exercises may be devised for the arms in cases 
where the upper limbs are ataxic as well as the lower ones. 

COUNTER-IRRITATION. 

Counter-irritation is a term applied to the use of substances irri- 
tating to the surface with which they come in contact, and is employed 
for the purpose of influencing morbid processes in more or less dis- 
tant parts or of affecting the general system. It has been thought 
that this method savors of the doctrine of "like cures like," but in 
reality it is based on sound physiological laws, and is so logical as to 
have been described by the founder of homoeopathy as useless. 

The entire basis for the employment of counter-irritation rests 
upon reflex action, or the conduction of a nervous impulse to a centre, 
which, when so stimulated, sends out an impulse to the part of the 
body which is diseased. 

The use of counter-irritation may be divided into four parts or 
purposes : The first is for affecting inflammations or congestions ; the 



460 REMEDIAL MEASURES OTHER THAN DRUGS. 

second for causing the absorption or removal of inflammatory depos- 
its after true inflammation has ceased ; while the third purpose is for 
the relief of pain ; and the fourth for the effect which can be exer- 
cised upon the general system by blisters in systemic disease. 

In the same manner that we can divide the indications for coun- 
ter-irritation into four parts, so can we also divide its forms into three 
varieties, according to their severity. The most severe are the caus- 
tics or escharotics, the next the epispastics or blisters, and finally the 
rubefacients or reddeners. 

The proper manner of employing a counter-irritant to affect inflam- 
mations is not to apply it directly to an actually inflamed area, but a 
little to one side of it or at a spot known to be connected intimately 
with the diseased area by nerve-fibres. 

Thus, it is well known that in diseases of the eye the blister 
should be applied back of the ear, and that in abdominal neuralgia 
or in pleurodynia the best results are reached, not from the applica- 
tion of a blister to the spot where the pain is felt, but to the point 
upon the vertebral column where the nerve at fault takes its exit. 
The reason for this is that pain is always referred to the peripheral 
end of an irritated nerve, and pleurodynia or abdominal pain often 
arise from vertebral disease or inflammation about the spinal liga- 
ments or the foramina of exit for the nerves. In a similar manner 
we sometimes apply a blister, in the early stages of hip disease, not 
to the knee or ankle, where the pain is felt, but at the seat of the 
trouble — namely, the hip. Counter-irritation is contraindicated by 
the presence of any acute inflammation directly under the spot wmere 
it is proposed to place a blister ; that is, if any reddening of the skin 
is present the blister or other form of irritation must not be applied 
there. If used at all, it must be some little distance away, or a series 
of small flying blisters should be placed around the inflamed zone. 
A flying blister is one which is small in area — say as large as a Lima 
bean — and of comparatively slight action, healing rapidly after its pri- 
mary effects have passed by. 

Among the inflammatory affections in ivhich we find counter-irri- 
tation very serviceable may be mentioned pleurisy, pneumonia, iritis, 
synovitis (rheumatic or traumatic), cerebritis, and peritonitis (acute 
or chronic). A host of more subacute or chronic inflammations are 
also benefited by this measure, some of which are gleet, chronically 
enlarged joints, and inflamed glands. In all these states the blister, 
or more rarely the rubefacient, is to be resorted to ; and while it is 
true that nearly all of these conditions are accompanied by fever, and 
that fever is generally held to be a contraindication to the use of 
counter-irritation, blisters undoubtedly do good at such times. In 
pneumonia or pleurisy, along with the use of veratrum viride in the 
very earliest stages of the disease, a cantharidal blister of the size 
of a silver dollar should be applied near the spot where the most pain 
is felt or on the back near the spine. Where joints are inflamed 
the blisters should be at some distance from the seat of the swelling, 
although it is often useful to place the counter-irritant on the inner or 
outer aspect of the knee-joint if the skin is not reddened. In peri- 



CO UNTER-IBBITA TIOK 



461 



tonitis the blisters are best applied directly over the seat of tender- 
ness, and in cerebritis at the nape of the neck. In gleet a little cam 

Fig. 63. 





Figure showing the areas iu which blisters are to be placed. 

P, Pericarditis; A, appendicitis : L, laryngitis ; V, vomiting or gastritis ; P L, pleuritis ; 
E, inflammation in joint. 



tharidal collodion may be painted along the under surface of the penis 
or upon the perineum with great advantage in obstinate cases. 

Where an inflammatory process is chronic and resists cantharidal 
blistering, then resort is often had to more severe forms of counter- 
irritation by means of the red-hot — not white-hot — iron, or the use of 
escharotics, such as caustic potash or caustic soda or arsenic. The rea- 
son for using these is that they all cause so much tissue-change in the 
part that the counter-irritation is very prolonged. Sometimes antimo- 
nial ointment is applied constantly until a slough forms, to accomplish 
the same purposes. 

For the removal of the products of inflammation we resort to can- 
tharidal blisters or drugs possessing powers as local irritants and at 
the same time as alteratives. Thus, in pleurisy with effusion it is 
very proper to employ a good-sized cantharidal blister if the effusion 



462 



REMEDIAL MEASURES OTHER THAN DRUGS. 



has a tendency to remain unabsorbed. Some have thought that the 
absorption which follows is due to the abstraction of serum which 
takes place in the bleb formed, but this is a mistaken idea, as one 
often sees an effusion absorbed which far exceeds in quantity the 
amount of liquid in the blister. Under these circumstances the spot 
for applying the blister is, as a rule, immediately under the arm, 
about two or three inches below the axilla. The blister, while it is 

Fig. 64. 




Figure showing the areas in which blisters are to be placed. 

0, earache or vertigo; if, meningeal inflammation or effusion at the base of the bruin; //, 
hemoptysis; P /.. pleuritis : /, intercostal neuralgia ; KS, renal or spinal irritation ; R, rheu- 
matism or inllammation in joint. 



useful in causing absorption in chronic effusions and deposits about 
joints, i- u<»t bo good as are alterative irritants; for example, iodine, 
which in the form of a thorough application at one sitting until the 
skin [fi black — not yellow or red — is often of service. In other cases, 
particularly in very chronic states, iodine ointment, alone or with 
lard, may be rubbed into the parte with advantage, care being taken 
to stop its use for a day or two as soon as the skin gets red. This 



CO UNTER-IRRITA TION. 463 

same treatment is also useful in treating enlarged glands in the neck 
and elsewhere before pus forms. 

One of the best treatments for epididymitis is to paint the scrotum 
black with many coatings of a strong solution of silver nitrate or 
iodine, to insist on total rest in bed, and to resort to the local use of 
cold. The testicles should also be supported by a suspensory or 
adhesive strips during this treatment, and aconite given if fever is 
present. 

For the relief of pain we very commonly resort to the rubefacients 
rather than epispastics, since the more moderate applications are 
equally effective in most instances, and do not leave skin lesions 
behind to remind the patient of his attack. 

Every one who has had stomach-ache and remembers the relief 
obtained by the use of a mustard plaster or spice plaster recognizes 
the value of this means of obtaining relief, and it only remains for 
the writer to state that headaches are often amenable to similar treat- 
ment. These headaches may be neuralgic or due to dyspepsia or to 
cerebral anaemia or congestion, but counter-irritation will neverthe- 
less do good. If neuralgic, a little menthol or oil of peppermint 
may be applied over the course of the nerve — which application, if it 
be supraorbital, will require care lest the oil gain access to the eye. 

For the treatment of pain in the belly or chest or elsewhere we 
have four means of producing counter-irritation in the shape of rube- 
facients : The first is mustard ; the second, capsicum ; the third, the 
turpentine stupe ; and the fourth, the spice poultice. 

The mustard plaster should be made by mixing mustard flour with 
warm vinegar or water, and adding varying proportions of ordinary 
flour to modify its action. If the skin is tender, half mustard and 
half wheat flour may be employed, or if a child is to be treated the 
proportion may have to be only one-fourth mustard. The plaster is 
made by placing a stout piece of paper on a table and putting over 
it a piece of heavy muslin or linen. On this is smeared the mus- 
tard, and over the mustard mass is placed a thin piece of linen, 
which prevents the poultice from adhering to the skin and modifies 
the burning according to its density. By folding the edges of the 
paper so that it resembles a picture-frame we have at a hand a cheap, 
effective, and strong plaster, the back of which is supported by the 
paper. 

The spice plaster is made by mixing equal parts of allspice, cloves, 
cinnamon, and nutmegs, and adding thereto one-half part of black 
pepper. These constituents are made into a homogeneous mass by 
using a knife-blade to mix them, and are then sewed up in a bag 
which is quilted to prevent sagging of the contents. One side of the 
poultice is now wetted with warm brandy, whiskey, or vinegar, and 
applied to the part desired. 

If the skin is tender the proportions of pepper and cloves should be 
decreased. 

This plaster may be allowed to remain over the affected parts for 
hours or even days, and is very useful in the treatment of gastric 
catarrh and indigestion, particularly those forms occurring in children. 



464 REMEDIAL MEASURES OTHER THAN DRUGS. 

The turpentine stupe (see Turpentine) is not to be allowed to 
remain very long on the skin, as it may blister a tender cuticle, and 
the pepper plaster may be so active as to produce unbearable pain if 
it is not watched. 

The proper way of treating all such burns from counter-irritation 
is to apply simple cerate, cosmoline, or sweet oil, to which may be 
added carbolic acid in the proportion of 1 : 100. The carbolic acid 
not only acts as an antiseptic, but as a local anaesthetic, while the oil 
acts as a protective from contact with the air. 

Much difference of opinion exists as to the proper treatment of the 
blister formed by cantharides. "Where the blisters are small — that is, 
the size of the end of a finger — they may be allowed to break of them- 
selves, and then be dressed with dry cotton ; if they are large, the 
blebs should be punctured at their most dependent part with an anti- 
septic needle and dressed with dry absorbent cotton, as by so doing the 
new skin rapidly forms underneath and is soon able to carry on its nor- 
mal functions. 

The proper treatment of the blister while it is forming is to apply 
a poultice, which will decrease the pain and aid in the formation of 
the bleb. 



CUPPING. 

Cups are used in two forms, the dry cups and the wet cups. The 
_rst depend almost entirely upon their counterirritant effect for their 
therapeutic value. A hollow glass fitted with a valve or stop-cock is 
placed upon the skin and exhausted by means of a small hand pump. 
The stop-cock is turned to prevent the entrance of air and the cup 
allowed to remain until sufficient air leaks into it to overcome the 

Fig. 65. 




Dry cups applied to the chest, as in a case of pulmonary oedema, the early stages of pneu- 
monia, or diffuse bronchitis. 

vacuum and lot it fall off. Several such cups placed over the bases 
of the lungs or kidneys overcome congestion and stasis in these 
organs. A wet cup is applied as is the dry, but before it is placed 
on the skill the cuticle is incised by a scalpel in several place-, so 
that it will bleed freely when the suction is produced in the cup. It 



DISINFECTION. 465 

is therefore both counterirritant and depletant, and is not to be used 
in feeble persons who cannot stand loss of blood. Dry cups are often 
employed, and are valuable aids in treating the conditions named. 
Dry cups are not to be used in acute pleurisy or peritonitis lest they 
injure the parietal serous membrane. 

DISINFECTION. 

Before discussing the subject of Disinfection, we must turn our 
attention to what we mean by the terms employed when speaking 
of this subject. At present we recognize that the word "germicide" 
is applicable solely to agents capable of killing the lower forms of 
life, whereas " antiseptics " are substances which render the material 
with which they come in contact so antagonistic or unsuited to germ- 
development as to render it impossible, at least in an active state. To 
use a simile : the killing of the inhabitants of a district by shooting 
them would stop all growth and be germicidal, whereas the destruction 
of the crops in those same parts would only be antiseptic ; or, in other 
words, the people might remain, but would starve to death. (See article 
on Antiseptics.) 

We speak of germicides as disinfectants, but never of antiseptics 
as disinfectants if we use these terms correctly, but "germicide'' and 
"disinfectant" are synonymous words. 

From what has just been said, it is evident that when dealing with 
filth we should always resort to disinfectants rather than antiseptics, 
for although the latter are good, the former are better. 

We have three ways of destroying germs which are particularly 
useful : The first is the total destruction not only of the germs, but 
also of their resting-place, by means of fire, which may be used in 
the case of old furniture, mattresses, and similar materials, and which 
may be extended to everything about the patient if it is necessary to 
stamp out a brisk epidemic before it can get well under way. The 
second is the use of moist heat in the form of superheated steam, or, 
better still for common purposes, the use of boiling water; and, 
thirdly, by means of disinfectant materials which have a proved 
reliability. 

Moist heat in the form of superheated steam is infinitely prefer- 
able to dry heat, but as superheated steam cannot be readily obtained, 
physicians usually direct the clothes to be boiled for at least two 
hours. 

Very often the bed-clothes are taken from a sick-room, trailed 
through the house, and finally deposited at any spot until a conve- 
nient time for boiling them occurs. This is radically wrong and capa- 
ble of causing a widespread distribution of the disease. In all such 
cases the bed-clothes should be rolled off the bed in a bundle and com- 
pletely submerged in a bucket or tub of boiling water, or, better still, 
in a corrosive-sublimate solution of the strength of 1 : 1000, before 
they are taken from the room. This tub is now to be carried at once 
to the fire, and the clothes lifted out dripping wet and plunged into a 
clothes-boiler in which the water is actively boiling. The lid of the 

30 



466 



REMEDIAL MEASURES OTHER THAN DRUGS. 



boiler is at once to be put on to increase the heat and prevent the 
escape of any germs in the steam or in the hot air which arises from 
the surface of the water. The active boiling should be continued for 
one or two hours, and water be continually added to prevent scorch- 
ing of the contents of the boiler. 

It is important that food be not cooked on the stove at the time 
the clothes are being boiled, and no food should be in the room. 

If boiling cannot be resorted to for any reason, the clothes may be 
soaked in a 1 : 500 solution of corrosive sublimate or a 1 : 20 solu- 
tion of carbolic acid, although neither of these is so sure a method of 
disinfection as boiling. 

The proper care of a room after it has been occupied by a case of 
infectious disease is of great importance, and is generally sadly mis- 
managed. Disinfection is best accomplished by formaldehyde gene- 
rators, which act by disengaging the gas from pastilles of formalin, by 
the heating of wood alcohol ; or by boiling a 40 per cent, solution of 
formaldehyde. The latter is the most efficient method. (See Formic 
aldehyde.) It does not injure dye-stuifs. 

Novy has invented a very useful generator, and when it is used the 
following rules should be followed : 



Fig. 66. 







Novy's formaldehyde generator. 



1. All openings in the plaster or in the floor, or about the doors 
and windows, should be caulked tight with cotton or with strips of 

cloth. 



DISINFECTION. 467 

2. The linen, quilts, blankets, carpets, etc., should be stretched 
out on a line, in order to expose as much surface to the disinfectant as 
possible. They should not be thrown into a heap. Books should be 
suspended by their covers so that the pages are all open and freely 
exposed. 

3. The walls and floor of the room and the articles contained in it 
should be thoroughly sprayed with water. If masses of matter or 
sputum are dried on the floor, they should be soaked with water and 
loosened. No vessel of water, however, should be allowed to remain 
in the room, as it will absorb the gas. 

4. One hundred and fifty cc. (5 ounces) of the commercial 40 per 
cent, solution of formaldehyde for each 1000 cubic feet of space should 
be placed in the generating apparatus, and (the delivery-tube being in 
proper position) volatilized as rapidly as possible. The keyhole and 
spaces about the door should then be packed with cotton or cloth. 

5. The room thus treated should remain closed for at least ten 
hours. If there is much leakage of gas into the surrounding rooms, a 
second or a third injection of formaldehyde at intervals of two or three 
hours should be made. 

A good method of disinfection is to take all movable objects out 
of doors into the fresh air, and then to wash the floor, sills, and 
casings, using a scrubbing-brush, hot water, and soap. The water 
remaining in the bucket should afterward be boiled to kill the germs 
which may be in it. This scrubbing being accomplished, the same 
surfaces should be scrubbed a second time with a solution of corrosive 
sublimate (1 : 500 or 1 : 1000) and left wet, so that the salt of mer- 
cury may remain on them. Cracks and crannies are to receive par- 
ticular attention. After this is done the floor should be flushed with 
a solution of formaldehyde. 

By far the best disinfectant for all diseases is good ventilation. 
Not only should as much air as possible be allowed to enter the sick- 
room, but after the case has vacated the premises the windows should 
remain open for weeks if possible. Fresh air dilutes germs as fresh 
water dissolves or dilutes dirt. 

Disinfection of the discharges of the patient is an important duty 
to be remembered. The urine and faeces should always be received 
in a vessel containing enough corrosive sublimate solution (1 : 500) 
to kill all germs, and to prevent their escape into the air or into 
water or food when the discharges are thrown away. The disinfect- 
ant should be placed in the bed-pan before, not after, it is used. 

The bed-pan or chamber should not be allowed to stand in the 
room, but be removed and emptied at once in such a manner that its 
contents cannot contaminate any water or food. Its contents should not 
be thrown upon the ground, as the air will dry them and cause the 
germs to be disseminated everywhere in the form of dust. In very 
contagious diseases bathing or swabbing off the patient with weak anti- 
septics may be tried. Thus 1 : 10,000 of bichloride of mercury may 
be used and the patient afterward wiped off with a wet towel. In other 
instances a 1 : 100 solution of carbolic acid in sweet oil may be employed 
to soften the skin, decrease itching, and disinfect the patient. 



468 REMEDIAL MEASURES OTHER THAN DRUGS. 

The question as to -which are the best disinfectant substances is 
one that has attracted the attention of physicians and original inves- 
tigators for years. The result of a vast amount of study and experi- 
ence shows that corrosive sublimate is the best of all disinfectants in 
the proportion of 1 : 250 to 1 : 500, or even weaker, but that for 
cheapness, activity, and general usefulness chlorinated lime is better 
still. The disadvantages in the use of corrosive sublimate lie in its 
ready decomposition, its formation of a harmless albuminate of mer- 
cury when albumin is present, its uselessness where lead pipes are 
present, and, above all, its expense. Chlorinated lime depends 
almost entirely upon its chlorine for any disinfectant power which 
it may possess. Chlorine gas itself is not readily handled, but the 
lime enables us to put it where we will. It cannot be employed to 
disinfect colored fabrics, as it bleaches them. (See Formaldehyde, 
Part II.) 

Whenever chlorinated lime is bought, the physician should see that 
all the chlorine has not departed from it, as most of the material kept 
in the stores is so old as to be worthless. 

For scrubbing floors, chlorinated lime may be made into a solution 
by adding a cupful to a bucket of water, and in privies it may be 
spread thickly over the surface of the mass of filth. 

It is useless to place chlorinated lime in saucers around a room 
for the purpose of disinfecting the air, as the amount of chlorine to the 
volume of air to be disinfected is as nothing. 

Copperas, or sulphate of iron, while largely used as a disinfectant 
by some persons, is in reality only an antiseptic. 

ENTEROCLYSIS. 

Enteroclysis, or the washing out of the bowel by means of large 
and slowly injected clysters for the purpose of medicating or cleans- 
ing both the large and small intestine, has within the last few years 
become one of the most valuable therapeutic measures we possess. 
Not only is it of value for the purposes named, but for the relief of 
intestinal obstruction, for the preservation of bodily heat by the use 
of hot water, and for the reduction of fever by the use of cold water. 

The treatment of choleraic diarrhoea in all its forms by enterocly- 
sis was first used by Cantani within the last decade. The method 
yielded such good results in his hands that he enthusiastically 
employed it in a large number of cases, and caused a number of 
other physicians to use it. The method consists in the slow irri- 
gation of the large and small bowel by way of the rectum, using 
;i solution urged on by the hydrostatic pressure of a fountain-syringe. 
The solution contains as its chief constituent tannic acid, which is 
added in the proportion of from 1 to 5 drachms to 2 quarts of water, 
and 1! ounces (45.0) of wine of opium. 

Carbolic acid is too poisonous, salicylic acid too insoluble, corro- 
sive sublimate too poisonous and too easily decomposed, to be used in 
this manner. 



ENTEROCLYSIS. 469 

In some cases Cantani employed a mixture made of 

Infusion of chamomile-fiWers - 2000 parts. 

Tannic acid 10 " 

Gum arabic 30 " 

Tincture of opium 2 " 

Cantani considers that the passage of the ileo-caecal valve is essen- 
tial for the success of his methods, and if this is the case the report- 
ers who have failed to obtain satisfactory results from this treatment 
have probably failed to do more than irrigate the colon. The import- 
ance of irrigating the ileum is great, since it is in this portion of 
the alimentary canal that the cholera germs are most active. Nor is 
this treatment by tannic-acid injections founded upon mere empiricism, 
for Cantani and others have found that tannic acid, in the strength of 
1 per cent., inhibits the growth of intestinal germs in one and a half 
hours at 98° F., while J per cent, in six hours seriously impairs their 
vitality. Cantani also asserts that tannic acid neutralizes the toxines 
formed by these micro-organisms. This treatment therefore contracts 
the leaking blood-vessels, stops the growth of the bacilli, prevents the 
absorption of toxines, acidifies the intestine, stimulates the nervous sys- 
tem, warms the body, prevents anuria, and avoids collapse. Many 
clinicians, however, do not believe that it is possible for the fluid to get 
by the ileo-csecal valve unless so great hydrostatic pressure is used as 
to be dangerous. 

The employment of irrigation of the colon in cases of dysentery is 
by no means of recent date. It is only, however, within the last few 
years that this method of treatment has been widely employed or 
studied. Aside from the fact that by this means we can bring medica- 
ments in direct contact with the diseased mucous membrazies, there is 
no doubt whatever that the mere passage of normal salt solution at 
suitable temperatures over the bowel-wall is of value, for in this manner 
we remove mucus and pus, and so dilute the poisons manufactured by 
the germs of the disease that their further action is largely inhibited. 
In adults the use of irrigation in dysentery should be carefully carried 
out by means of an inflow and outflow tube, the first being attached to 
a fountain syringe. The outflow tube must be large enough to permit 
of the liquid leaving the bowel with a readiness equal to that of its 
inflow, and must be so straight and patulous as to permit of the fluid 
carrying away with it any flakes of mucus or other foreign matter 
from the bowel. The method employed in giving the injection, the 
temperature of the water, and the gentleness of the operation are 
exceedingly important, and will be discussed on the succeeding page. 
The amount of water employed in irrigation of the bowel in dysentery 
is not to be measured by quarts, but by results. It should continue 
to flow in until it comes from the outflow tube perfectly clear, showing 
that our object — namely, thorough cleansing of the bowel — has been 
accomplished. The best medicament to be added to the water is boric 
acid or tannic acid, each of which is harmless and capable of doing 
much good. In nearly all instances in which we wish to cleanse the 



470 REMEDIAL MEASURES OTHER THAN DRUGS. 

bowel a normal salt solution should be employed rather than pure 
water, as the latter tends to irritate the intestinal wall. 

The question as to what is the best method of treating a case of 
intestinal obstruction by other than operative means is one which is 
of interest to the physician as well as the surgeon. Such cases gen- 
erally come into the hands of the general practitioner first, and it is 
for him to decide, as a rule, whether the surgeon shall be called in 
consultation. Measures devoted to the relief of the patient without 
the use of the knife are first to be tried. No one who has studied 
this subject can doubt that enteroclysis is a valuable measure in 
certain cases. Used properly, there is little danger of its doing 
harm, and some chance of its accomplishing good. The author is 
not one of those who place much confidence in the reports of cases 
of volvulus overcome by this means. The true indication for rectal 
injections is intussusception or obstruction due to impacted faeces. 
Even in such cases the injection treatment should not be persisted in 
for a period exceeding twelve hours. If the second injection fails to 
give relief, operation must be resorted to. 

A very important point to be decided in connection with this sub- 
ject is the amount of pressure that can be used with the stream of water 
which is employed, the length of time during which the injection may 
be given, and, finally, the temperature and character of the fluid 
injected. As is well known, the great majority of cases of intussus- 
ception take place at the ileo-csecal valve, and, if not here, in the sig- 
moid flexure. Pressure by injection is therefore readily brought to 
bear on the area involved. It has been claimed that certain pressures 
will cause rupture of the peritoneal coat of the intestine, but Dr. Martin 
and the writer failed to produce this lesion in the dog by any pressure 
we could employ, since before this occurred the liquid passed through 
the stomach and mouth. To employ a pressure exceeding eight pounds 
is, however, distinctly dangerous, not because the intestinal wall in 
health will not stand this, as a rule, but because it is near the injury 
line, and if any disease or softening of the bowel exist, it is almost cer- 
tain to cause rupture. A pressure of from two to five pounds is, as a 
rule, as much as may be employed, and this pressure should be obtained 
by degrees, starting the injection at such a point of pressure that it 
amounts to hardly more than a trickle, and increasing the pressure as 
the antagonism of the bowel is overcome. Finally, when the bowel is 
fully distended up to the point of obstruction, the pressure on the no 
longer moving column of water may be increased, if necessary, to six 
or eight pounds by raising the bag of water not more than three feet. 
In infants, in whom invagination so often occurs, a pressure greater 
than two pounds is dangerous, and it is of vital importance that the 
pressure be employed properly, otherwise it will do more harm than 
good in several ways. As a rule, in our anxiety to give the patient 
relief at once we are inclined to use too much force and too large a bulk 
of water, and think that active force, if such a term may be used, is to 
be resorted to. Those who have seen these cases have learned by 
experience the harmfulness of such measures, and have also learned 
how greal is tli«' expulsive power of the bowel when it is excited to 



ENTEROCLYSIS. 471 

contraction. If this power be brought into activity, it will be almost 
impossible to inject fluid into the rectum, and, worse than all, the mus- 
cular fibres of the intussuscipiens take a still tighter grasp on the 
intussusceptum. 

The dangerous practice of using a Davidson or any other kind of 
artificial-force syringe in the treatment of this class of cases is to be 
condemned. Three unreported cases of rupture of the bowel and death 
from the employment of the Davidson syringe for this purpose have 
occurred, because the amount of force used was indeterminable, and 
because it was injected with a jerking instead of a constant flow. The 
amount of fluid injected should be large, and if it is impossible to get 
a large amount into the bowel, it is probably because the inflow has 
been so rapid as to excite intestinal opposition. If, by a slow trickle 
of water into the bowel, gradually increasing the pressure, we are 
unable to give relief in forty-five minutes, it is necessary either to 
give this treatment up as useless, or else allow the liquid to flow away 
and resort to the measure again in some hours. Practical experience 
has shown that the second or third injection sometimes succeeds, prob- 
ably because it is more skilfully given and the first has prepared 
the way for the others, but it is to be remembered that the chances 
for reduction of the obstruction are best with the first injection if it 
is properly given. Freqjiently-repeated small injections are abso- 
lutely unjustifiable, as they tend only to cause spasm of the bowel. 

Finally, the author cannot leave this subject without saying a word 
concerning the temperature of the injected liquid and its constitution. 
An injection of this kind goes into the very heat-citadel of the body, 
and if too cold, as it often is, produces dangerous chilling of organs 
which are ordinarily especially protected from cold by the omental 
apron and intestines. By repeated experiments, Martin and the author 
found that water at 65° F. lowered the bodily heat three degrees in 
thirty minutes. The use of colder water than this (52° F.) resulted 
in death in twelve hours, and the post-mortem showed intense conges- 
tion of the colon, which contained bloody mucus. 

The use of water of too high a temperature is also dangerous, lest 
it produce heat-stroke. Of course no one would use water hot enough 
to produce local harm, yet it is necessary to have just enough heat 
and no more. Martin and the author proved that the use of water 
at 115° F. caused in twenty-five minutes a rise of bodily tempera- 
ture in the axilla of nearly five degres, and developed marked symp- 
toms of heat-dyspnoea. The temperature which it is right to employ 
we found to be 101° to 103° F. as the water entered the bowel, or 
even as high as 104° F. in the water-bag if a long tube was used, as 
under these circumstances the water is rapidly cooled. An interest- 
ing result of these experiments as to heat is that when cold water 
was used it took four times as long to make the injection as when 
moderately warm water was employed. 

If very large injections are used, a normal saline solution of 
7 : 1000 (1 drachm to 1 pint) should be employed to avoid the abstrac- 
tion of vital salts from the intestinal wall, with consequent passage 
of water into the tissues, making them boggy, according to the law 



472 



REMEDIAL MEASURES OTHER THAN DRUGS. 



of osmosis. Such injections are very useful to relieve thirst and keep 
the kidneys active after abdominal operations. 

In regard to the effect of distention of the bowel by injection on 
the circulation and respiration, there is practically none, but the pas- 
sage of large amounts of warmed fluid directly into the closed ab- 
dominal cavity causes death rapidly. 

GAVAGE. 

Gavage is a term applied to the forced feeding of patients who will 
not or can not swallow food. The method is often employed in nour- 
ishing the insane who refuse to take food. A soft-rubber catheter is 




Showing the introduction of a soft catheter through the righl side of the nose In the practice 

of gavage. 



passed through one of the nasal chambers back into the pharynx, a 
small funnel is attached to its outer extremity, and the milk, or beef- 
broth, or other liquid food is by this means introduced into the 



pharynx, where the muscles of deglutition seize 



it. 



HEAT. 473 

is also correctly employed to the forced feeding of a patient by an 
oesophageal tube, as in the use of lavage. (See Lavage.) 

HEAT. 

Heat is used locally for a number of purposes in the same manner 
as is cold, and, as was stated in the article on Cold, the choice of heat 
or cold in the treatment of any acute form of inflammation depends 
almost entirely upon the wish of the patient, who generally can tell 
at once which will give him the greater comfort. 

In sprains of the ankle nothing compares to a hot foot-bath pro- 
longed for hours, the object being to decrease the pain and swelling, 
thereby regaining the use of the limb. To carry this out effectively, 
a piece of rubber tubing of small size should be led from a wooden 
bucket, which, being a bad conductor of heat, prevents the water 
from being rapidly chilled, to a sink or large tub near by, when 
by starting the water by suction a continuous but very small stream 
can be made to flow from the bucket, while by means of another sim- 
ilar arrangement running either from another tub — or, better still, 
from a hot-water spigot — a small stream of hot water continually 
enters to take the place of that withdrawn by the first siphon. Under 
these circumstances a very constant temperature of the water can 
readily be maintained. The high degree of heat which can be borne 
by gradually increasing the temperature of the water in the supply- 
tube is very extraordinary, the favorable results obtained being in 
direct ratio to the height of the temperature. Between these soak- 
ings the part should be dressed with lead-water and laudanum, and 
rubbed with ichthyol ointment or camphor liniment and laudanum. 

In spasmodic affections involving either striped or unstriped mus- 
cular fibre the local application of heat is a very useful means of 
relief. Sometimes in lumbago or muscular stiffness in other parts of 
the body the use of an ordinary laundry iron over the affected part 
will prove of great service, the skin being covered by several layers 
of newspaper to afford a smooth surface over which to pass the iron 
and to protect the parts from too great heat. 

In chordee the best means for rapid relief, other than the use of 
drugs or general relaxants, such as amyl nitrite, is to steep the penis 
in hot water. A hot sitz-bath before going to bed is a good prophy- 
lactic against this painful complication of gonorrhoea. 

In croup of the spasmodic type the local application of a hot com- 
press, made by wetting spongiopiline with hot water, is very useful, 
or, if spongiopiline cannot be had, several layers of flannel should be 
wetted, placed on the neck, and covered with cotton and oil-silk so as 
to prevent the roll becoming chilled. 

Nearly all forms of pain in the eyes can be much relieved by the 
application of heat. Thus iritis, corneal irritation and ulceration, and 
pain due to eye-strain can be greatly relieved by the use of hot water 
applied by cotton pledgets frequently renewed, but never allowed to 
remain on long enough to act as warm poultices. Another method is to 
allow water as hot as can be borne to drop upon the eye from a foun- 



474 REMEDIAL MEASURES OTHER THAN DRUGS. 

tain-syringe. The fountain-bag should not be more than two feet 
above the patient's head, and the fluid should drop on the eyelid for 
the distance of a few inches only. 

Where attacks of dysmenorrhea depend upon spasmodic closure 
of the cervix, with simultaneous spasm of the fundus uteri, a hot sitz- 
bath or hot vaginal injection is useful, and this treatment is also of 
value where uterine congestion results in leucorrhoea or a sensation 
of weight in the pelvis. 

Sometimes attacks of torticollis may be subdued by applying hot 
compresses to the sterno-mastoid muscle. 

The local application of heat may serve to determine whether the 
inflammatory process has gone on to the formation of pus. Before 
pus is formed heat decreases the pain, it is claimed by Lewin, but 
afterward greatly increases it. 

The use of heat in two forms has been and is largely used at 
present for medicinal purposes, when the skin or kidneys are torpid, 
to aid in the elimination of impure and effete materials from the 
blood and tissues. These two forms of heat, the dry and the moist, 
are commonly called the Turkish and Russian baths respectively, and 
may be taken under home arrangements or in one of the establish- 
ments found in all large cities. 

The first of these is in the form of dry heat, the second is moist 
heat. The Turkish bath consists of a series of rooms ranging in tem- 
perature from 100° F. to 150° F. or more, into which the individual 
passes successively until the hottest room is reached. In each cham- 
ber he lingers until the system becomes accustomed to the high tem- 
perature, and perspiration is well established before he enters the 
hottest room, where he remains for a varying length of time accord- 
ing to the advice of his physician or his own whim or comfdrt. The 
rule governing his stay is that he must leave it at once if any sense 
of oppression is experienced or if perspiration does not flow freely. 
Sometimes a glass of cold water taken at this time causes a sudden 
profuse sweat, and also relieves any overheating by abstracting many 
units of heat. The cold water in the centre of the body causes con- 
traction of the blood-vessels in these parts, and the blood, rushing to 
the surface, causes the sweat-glands to pour out their secretion. 

Following the stay in the warm room, the individual passes into 
still another chamber, where he is shampooed from head to foot, well 
rubbed, and the blood made to circulate through the skin. The 
shower-bath is then used, at first hot or warm, and finally changed to 
a dash of cold, or, better still, the patient plunges into a long tank, 
swims to the other end, and is there met by an attendant who rapidly 
dries his skin, wraps a cover round him, and shows him to a lounge, 
where lie is supposed to recline and sleep for an hour or less. The 
air of this sleeping-room is at the ordinary temperature of a living- 
room. 

Reviewing for a moment the effects of this bath, we find that the 
first two-thirds are devoted to the opening and stimulation of the 
pores of* the skin, while the Last third is devoted to the contraction 
of these pores and their supplying blood-vessels. In other words, it; 



BEAT. 475 

is necessary to use the cold to prevent gradual chilling of limited 
areas, which would result in internal congestion. If the patient 
receives a cold douche, the natural rebound prevents congestion of a 
permanent nature, whereas if he is exposed to cold a long time, these 
stagnated areas become permanently diseased. The physician must 
always remember that this cold douche or plunge is a sine qua non, 
and that a rest after the bath before dressing is almost equally 
important. If the patient is too weak to bear the cold, he must not 
use the bath. 

The indication for the Turkish bath as a medicinal measure is any 
condition of the emunctories of the body whereby effete matters are 
not properly eliminated, as in Bright's disease in its various forms. 
The increased action of the skin not' only casts off impurities for the 
time being, but frequent repetition of the bath causes functional 
hypertrophy of the sweat-glands, and eventually enables them to do 
more work, or, in other words, to cast off an increased quantity of 
effete material. As a consequence of this the patient is able to avoid 
uraemia or other evidences of Bright's disease, and, employing the 
normal epithelium still left in the kidney for constant use, uses the 
bath once, twice, or thrice a week with the object of abstracting the 
excess of impurities which the impaired kidneys cannot remove. 
The frequency of the bath depends, therefore, upon the rapidity 
with which the effete materials accumulate. In a case of Bright's 
disease the patient should not attempt to use the room containing 
high heat at first, and should be accompanied by a medical attendant 
to watch for untoAvard effects, particularly if the heart is diseased 
or uraemia is already shown by headache or other signs. If sweat- 
ing does not come on at once, danger is at hand from acute uraemia, 
renal and cerebral congestion, or heat-stroke. 

Not only is the Turkish bath useful for kidney disease, but it is 
often of great service in rheumatism. The acute form of rheumatism 
is rarely so treated, because cardiac complications often forbid expo- 
sure to heat, and fever is generally present. In subacute and chronic 
rheumatism the case is different, and the enlarged joints or inflamed 
muscles yield like magic in some instances to such treatment. Fur- 
ther than this, the muscular stiffness following prolonged or severe 
effort can be so avoided, and neuralgia depending upon rheumatic or 
gouty taint may be relieved by the hot-air bath. 

Acute colds affecting the nasal cavities or other parts of the bodv, at 
an early formative stage, can often be aborted by a good Turkish bath, 
and when further developed are often greatly relieved by the same 
means. If, however, congestion of the lung, pneumonia, or chronic 
bronchitis, with emphysema or a dilated weak heart, are present, the 
bath may be dangerous. In acute pharyngitis, in which the pharynx 
feels like a raw surface or "as if it were filed or scraped," the bath 
will give relief in many instances. 

Sometimes in suppression of menstruation from cold the flow may 
be restored by a Turkish bath. 

Some persons complain that they are always catching cold upon 
the slightest provocation and apparently without cause. One class 



476 



REMEDIAL MEASURES OTHER THAN DRUGS. 



seem to have delicate mucous membranes readily susceptible to irri- 
tation and inflammation ; the other have dilated or relaxed peripheral 
capillaries, which readily allow the blood in them to become chilled, 
and the individual consequently suffers from internal local congestions. 
Two separate means of treating such cases exist. The first set will 
do well on minute doses of arsenous acid (grain y^-g- to -g^) three times 
a day, used for weeks ; the second will be cured of their habit by 
the use of a Turkish bath twice or thrice a week, since by this means 
the peripheral capillaries are toned up and made more active. 

The Turkish bath, as thoroughly carried out in large cities, is not 
obtainable for those living elsewhere, so it is well to describe a home 
modification which, with attention to detail and care, may prove 
almost, if not quite, as effective* a remedy. (See Fig. 49, p. 301.) 

The patient is placed upon a chair, naked, and under the chair 
a small alcohol lamp is put, which is lighted. The individual is now 
wrapped thoroughly, chair and all, with one or two large blankets, 
and the heat of the lamp soon causes profuse sweating. Many cases 
are, however, on record where the lamp has been upset and the 
patient badly burned. The best way is to have the lamp a little 
to one side and its flame immediately under the mouth of an inverted 
funnel attached to a piece of tin tubing, the free end of which is 
placed under the blanket, so that the hot air and vapor may surround 
the body. If the tube be covered with cloth, the loss of heat is 
slight and the danger of burning the patient is removed. If this is 
not practicable, several very hot bricks or stones, thoroughly heated 
in an oven, may be placed under the chair, or small heated logs may 

Fig. 68. 




method of riving a bed-ridden patient a hot-air bath where a sweat is desirable, or where 

shock with a collapse temperature is to be controlled. The bed-Clothing is raised by a 
cradle. An alcohol-lainp is placed under the inverted funnel, and the hot. moist air is 
carried in this way to the patient without any danger of lire or of burning the .skin by hot 
bottles. 

be substituted. When the patient is too feeble to leave the bed, then 



it IS wise CO place an alcohol lain]) 



at the foot of the couch, with 



an 



HEAT. 



477 



inverted funnel attached to a tube which passes under the bed- 
clothes in such a way as not to bring the hot air directly against the 
skin of the patient. The bed-clothing may be slightly raised to 
allow the hot air to enter. The vapor of the alcohol lamp tends to 
sweat the patient. This is also a valuable mode of using external 
heat in cases of shock. (Fig. 68.) 



%' 



Fig. 69. 



r: 





Nurses using two broom-sticks to wring out a blanket clipped in very hot water for use in the 
hot pack. (From the author's wards.) 

The Russian bath differs from the Turkish in that the heat used is 
moist, not dry. As a consequence the danger of heat-stroke and simi- 
lar states is much increased, because evaporation from the skin does not 
go on so rapidly and the body is not cooled so well. 

The hot moist bath can also be obtained by seating the patient on 
a wicker chair under which is placed a bucket of hot water. The 
patient is surrounded by a blanket, and a large hot iron or stone is put 
into the water, causing the development of a great amount of steam. 

This method of treatment is useful in the same states as is the 
Turkish bath, but is more rarely used. It may also be employed to 
develop the rash of any of the exanthematous fevers when it is sup- 
pressed by cold or is not "well out" on the skin. 

Under the name (.f the "hot pack" still another substitute for the 
Turkish or Russian bath is used, not only to cause sweating and so 



478 REMEDIAL MEASURES OTHER THAN DRUGS. 

relieve the patient of poisons and fluid in renal diseases, but also to 
relax muscle spasm and to relieve nervous excitement and nervous 
insomnia. It is particularly efficacious in the nervous insomnia of 
severe chorea in children, and may be used in tetanus. 

A bed is prepared by covering it with a rubber blanket. Over this 
is placed a dry woollen blanket. A large, heavy blanket is now dipped 
in very hot water and then wrung out (see Fig. 69), and the naked 
patient quickly wrapped in it, the dry blanket being folded over him 
after several hot-water bottles have been placed alongside the patient. 
Finally the sides of the rubber sheet are drawn around and over the 
patient and an ice-cap placed on the head. (Fig. 70.) A thermom- 

Fig. 70. 







Showing arrangemeiit of blankets in giving a hot pack for uraemia. (From the author's wards.) 

eter should be placed in the mouth every half hour, and if the patient's 
temperature becomes febrile (101°) he should be taken out of the 
blankets and rubbed dry. Ordinarily the bath should last about one 
hour, and if sweating does not speedily come on a glass of cold water 
should be taken to drive the blood to the skin. In adults a little gin 
may be added to it, or sweet spirit of nitre may be used in this way in 
children or adults. If no sweat develops and the temperature begins 
to rise, the patient must be taken out of the bath at once. 

Another wet pack, which speedily becomes a warm one, is used in 
cases in which, during the course of an eruptive fever, the eruption fades 
and it is desired to bring it out on the surf ice. It is also useful in those 
cases of severe chorea in which the child can stand the first shock of 
the cold. It consists in wrapping the child in a cool wet sheet and 
over this wrapping one or two blankets. In a few minutes the sheet 
becomes heated by the body and the sweating which results is profuse. 

Whenever the Turkish or Russian bath is used, except in the 
exanthematous fevers, it should be followed by a cold sponge, plunge, 
or douche. 

Although these baths have been used in the treatment of cases of 
heart disease to relieve dropsy and renal engorgement, they arc not 
safe, and should not be generally employed. All acute or chronic 
diseases of the lung, except acute bronchitis of a mild form, contra- 
indicate their use. 

A valuable method for using moist heat in a mild form is the 
u bronchitis tent.'' (See article on Bronchitis.) 



HEAT. 479 

The use of a high degree of dry heat for the cure of inflammatory 

Fig. 71. 




Frazier-Lentz hot-air apparatus. 



states of the sheaths of the joints and muscles has recently been 
made once more popular by the introduction of a double copper 



Fig. 72. 




Kelley's hot-air apparatus. 



cylinder closed at one end, inside of which is placed the limb which 
is affected. The limb is prevented from coming in contact with the 



480 REMEDIAL 3IEASURES OTHER THAN DRUGS. 

cylinder by means of a board padded with asbestos and by putting 
pads of linen under the parts which touch the asbestos. A thermom- 
eter is placed so that its bulb extends into the cylinder, and a few 
holes permit of the moderate circulation of air. Bunsen burners or 
alcohol lamps are now lighted and placed under the cylinder, and the 
orifice through which the limb enters it is closed by drawing around 
the limb an asbestos curtain. The temperature is allowed to rise to 
200° to 300° F., and the treatment resorted to daily, or several times 
a week, the individual seance lasting about one hour. The free sweat- 
ing of the limb and the circulation of the blood and lymph prevent 
it from being burnt, but care must be taken that it does not touch 
the metal. Usually the entire surface of the body breaks out in a 
profuse sweat during the sitting. 

The author believes this method to be of great value in cases of 
chronic inflammatory joint- affections due to rheumatism or following 
injuries, but of little service in those due to gouty swelling. In sub- 
acute gout he has seen it precipitate an attack of universal acute 
gout, apparently by setting free large amounts of uric acid from the 
affected joints. 

The best form of this apparatus is expensive, and can be obtained 
from various instrument-makers. It is always to be considered as a 
valuable aid in the treatment of the more obstinate cases of the char- 
acter described. A less expensive apparatus is shown in Fig. 72. 

HYPODERMOCLYSIS. 

Hypodermoclysis is a method of supplying fluid to the body to 
replace that lost through excessive purging, as in cholera, or in cases 
of hemorrhage. Further, it may be used to wash from the body 
various impurities circulating in the blood and lymph and to flush 
the kidneys. In other instances it may be used to supply the body 
with liquid when the stomach will not permit drink to be swallowed, as 
in vomiting or gastric ulcer or after abdominal operations. It con- 
sists in the introduction into the subcutaneous tissues of normal saline 
solution, which is rapidly absorbed by the vessels. As is well known, 
a quantity of liquid equal to four times that of the normal amount of 
blood may be passed directly into the veins without producing arise 
of blood-pressure, and experiment has shown that usually within fifteen 
minutes after the fluid flows into the subcutaneous tissues an increased 
flow from the kidneys takes place. It is not safe to infuse a greater 
quantity of liquid than 1 drachm to each pound of body-weight in 
each fifteen minutes, as, if this amount is exceeded, the accumulation 
of the liquid in the system is so great that the tissues become bathed 
and finally drowned, because the kidneys cannot excrete the liquid 
fast enough. To carry out the operation, the sterilized liquid to be 
infused — the formula on page 505 is the best — is placed in a glass 
irrigator jar or rubber bag, which is absolutely aseptic, and to which 
air gains access only by means of a glass tube filled with sterilized cot- 
ton. From the lower part of the vessel leads a rubber tube to which 
is attached a canula, also rendered sterile. The skin over the place 



HYPODERMOCL YSIS. 



481 



where the liquid is to enter is to be rendered absolutely sterile, the 
trocar is then inserted into the subcutaneous tissue of the thigh, or, 
preferably, of the abdomen, or below the breast, and the liquid allowed 
to flow at the rate named, the pressure being obtained by raising the 
container two or three feet above the belly-wall. (Fig. 73.) As the 
liquid enters, a swelling appears in the subcutaneous tissues, which 
soon disappears after the infusion ceases, and is much aided in its 
absorption by the use of very gentle rubbing or stroking. 

Fig. 73. 




The apparatus and method used in giving hypodermoclysis. The ordinary irrigator is attached 
to a small canula, and this is placed in the loose tissues of the'belly-wall. 

When hypodermoclysis is employed after hemorrhage the results 
are often extraordinary. It is of great value in the collapse of 
cholera. The cyanosis decreases rapidly, the pulse improves wonder- 
fully, and the respirations are no longer difficult. Some physicians 
have used hypodermoclysis with very good results in the treatment 
of uraemia, and the author believes that not only are the poisons 
washed out of the system by this method, but, in addition, that the 
dilution of the poisons prevents them from acting so forcibly. In 
septicaemia, diabetic coma, and similar states this method of treat- 
ment should be employed and the results carefully recorded and re- 
ported. When general dropsy is present it is manifestly useless. 
Hypodermoclysis has also been used with great advantage in the treat- 
ment of severe burns to overcome shock and toxaemia. 

In cases of surgical shock warm saline fluid used by hypoder- 
moclysis is often of great service. (See also Intravenous Injection; 
Transfusion.) 



31 



482 REMEDIAL MEASURES OTHER THAN DRUGS. 



INHALATIONS. 

The value of inhalations is not recognized sufficiently by the 
medical profession. As a matter of fact, they are capable of aiding 
us very much in the treatment of disease and of producing results 
otherwise unobtainable. The employment of inhalations may be 
divided into the properly modified use of atmospheric air and the 
employment of atmospheric air laden with medicinal substances. To 
carry on many of the forms of treatment which have been found of 
value requires cumbersome or costly apparatus which cannot be used 
except in institutions ; but nevertheless the general practitioner can 
employ remedial measures by way of the respiratory organs with 
great advantage to himself and his patients even when far removed 
from places where costly apparatus can be had. 

The first form of inhalation to be studied is that which is devoted 
to proper respiratory exercises. These exercises are required by 
patients who because of faulty development do not properly expand 
certain portions of the chest in the function of respiration and by 
those who have acquired impaired respiratory movements by the fol- 
lowing of certain occupations, or as the result of attacks of disease. 

There can be no doubt that pulmonary tuberculosis may be pre- 
vented, or even arrested in its earliest stages, by causing a patient to 
use proper thoracic exercises, which must usually be directed toward 
producing expansion of the apices of the lungs, a part of these organs 
which in many instances is but poorly filled and equally ineffectively 
emptied under ordinary conditions of life. The following inhalation 
exercises are to be directed for such cases: 

The patient stands with his back against a wall, holding himself 
as erect as possible and bringing his shoulder-blades flat against the 
plane behind him. He now takes a slow, deep, and full inspiration, 
drawing the air into the chest in a steady stream, and not by a sudden 
jerk of his respiratory muscles. The inspired air is then to be held 
in the chest while the patient mentally counts three, and then allowed 
to escape gradually, and not forced out of the chest by sudden mus- 
cular effort. Usually four or five such movements night and morn- 
ing are quite sufficient for good results for the first week. After that 
they may be gradually increased in number. 

Another movement may now be added to that just described. 
The patient, standing with the back against the wall and the shoul- 
ders well thrown back, raises his arms, which are completely extended, 
from his sides until the hands are on a level with the shoulders, 
thereby fully expanding the sides of the chest. As expiration begins 
the arms are allowed to fall gradually to the sides. After this the 
arms may be carried above the head into a perpendicular position. 

A third exercise consists in inhaling as deeply as possible and 
then exhaling against resistance produced by closing the lips and 
forcing the air between them. 

The fourth exercise consists in Lying upon a firm bed with a small 
pillow under the hollow of the back and no pillow under the head, and 



INHALATIONS. 



483 



then taking slow, long-drawn inspirations and expirations as already 
described. 



Fig. 74. 



Fig. 75. 





Standing erect. 



stretch standing. 



These exercises are not only useful in persons with faulty chest 
development, but in those who have poor expansion of a lung after 
a pneumonia, pleurisy, or empyema. 



Fig. 76. 



Fig. 





Wing standing, side bendin 



Wing standing, trunk rotation. 



The increase in the volume of air respired under gentle but per- 
sistently taken exercises of this character is quite remarkable and 



484 



REMEDIAL MEASURES OTHER THAN DRUGS. 



they often increase the appetite, the quantity of haemoglobin, and 
the general health of the patient. 



Fig. 



Fig. 79. 





Wing standing, knee bending 
or curtseying. 



stride standing, forward bending, or hewing. 



In addition to these exercises there are others which, while not 
directlv connected with breathing, produce nevertheless deeper respi- 



Fig. 80. 



Fig. 81. 





Half w ill'..', half Stretch, standing: 
forward bending, or sawing. 



Wing standing, leg circling. 



rations and ;it the same time develop the chest muscles and cause the 
patient to hold himself erect, thereby preventing or correcting faulty 



INHALATIONS. 



485 



pulmonary expansion. Nearly every physician can look back upon 
cases in which a slovenly carriage of the shoulders in early life has 
resulted in impaired chest expansion and finally in actual disease. 
The exercises to be ordered are shown in Figs. 74-81. 

The next class of exercises consist in using simple forms of appa- 
ratus in association with respiratory movements. These are advan- 
tageous not only because they are beneficial in themselves, but also 
because they amuse the patient and cause him to take exercises of 
which he might tire if they were performed without appliances. 

The first of these consists in a pair of Wolff bottles joined together 
by a piece of rubber tubing (Fig. 82). The bottle nearest the patient 



Fig. 82. 




Arrangement of bottles for promoting lung expansion. 

is filled with water, and the patient after taking a deep inspiration at 
the moment of expiration places a mouth-piece attached to a rubber 
tube between his lips and forces the water over from the first to the 
second bottle. This is usually sufficient for an exercise, and later in 
the day the patient drives the fluid from one bottle to the other a 
second time. Such a procedure causes the patient to take fall inspi- 
rations and forcible, though gradual, expirations, with the result that 
he fully expands portions of the lungs hitherto but imperfectly inflated. 
It is therefore of value in patients with poorly developed chests, in 
cases after an attack of pneumonia, when complete resolution is long- 
delayed, and in instances of deficient pulmonary expansion because of 
adhesions following an attack of pleurisy. In cases of empyema after 
drainage is established it is useful in that it aids drainage, keeps the 
pleural cavity free from pus, and gradually causes the lung to descend 
once more into the lower part of the thorax. This practice is a very 
useful one in children, who may otherwise suffer from deformity due to 
collapse of one side of the chest if the lung is not properly expanded. 
It is not to be practised immediately after the removal of a pleural 
effusion or empyema, because time must be given the lung to expand 
naturally and adjust itself to the relief of pressure. 

Another form of apparatus, designed for the same purpose as that 
just named, is tw Denison's Resistance Inhaler." (See Fig. 83.) The 
physician having determined that the patient is to inhale air against 



486 



REMEDIAL MEASURES OTHER THAN DRUGS. 



resistance, the valve is fixed to yield to a pressure caused by his 
forcible inspiration. On the other hand, when the patient exhales 
the muscles of the chest must use sufficient pressure to force the air 
past the expiration valve. The result is that every part of the lung 




Denison's resistance inhaler. When in use the cap at the end of ihe inhaler is removed and 
air is drawn into the square chamber, which contains a piece oi folded absorbent paper or 
cotton wet with some of the volatile oils named in the text. The air then passes to the 
patient by way of the mouth-piece, meeting, however, a resistance valve on the way 
designed to produce forced inhalations. On expiration the air goes through the mouth- 
piece as far as the perforated elevated column, where, by a valve, it escapes. By means 
of the cap on top of this column the resistance offered by the valve to the escape of the 
air is increased or diminished as is desired, so that the patient expires against resistance. 

is expanded, the respiratory muscles are exercised and strengthened, 
and what might be called slovenly or imperfect breathing is corrected. 
We now pass to the consideration of inhalations designed to carry 
medicinal substances into the lungs for their effect on the respiratory 
tract or to influence the general system, not including however the 

Fig. 84. 




Chamber inhaler (Hassall). Theshelves are made of cotton cloth, upon which is poured the 

medicine to be employed. 



use of genera] anaesthetics. The air respired may be medicated by 
the following methods: (1) Setting free in the air of the patient's 
room volatile substances derived from chemical or vegetable sources, 
using materials which arc naturally volatile or which can be made 
SO by the aid of dry or moist heat. (2) The use of a mask or inhaler 



INHALATIONS. 



487 



so arranged that a part at least of the inspired air must pass through 
or over a sponge or piece of cotton moistened with the medicament. 
(3) The nebulizing of substances which are not volatile, by the use 
of compressed air. 

The use of chloride of ammonium fumes in cases of chronic bron- 
chitis is described in the article on Ammonium Chloride. In cases 
of spasmodic croup we can volatilize a few crystals of menthol placed 
in an iron spoon and held over a gas jet or lamp chimney, and so dif- 
fuse the vapor through the air. (See Croup.) 

Creosote is said to produce very good effects in whooping-cough, 
and in bronchitis in its later stages, if cloths wet with it are hung about 
the patient's room. So, too, turpentine, terebene, eucalyptol, and 
similar substances can be used in place of creosote, and in doing so 
the apparatus for diffusing these drugs in the air described by Hassell 
may be employed. (Fig. 84.) 

In other instances it is better to set free these and other substances 
by the aid of steam, allowing the steam to escape freely into the air of 
the room or to enter a "bronchitis tent " (see article on Bronchitis). 
5 to 20 minims (0.3-1.3) of any of the substances just named may be 
added to the water when it is boiling. Menthol may also be so used, 
placing 2 to 5 grains (0.13-0.3) in the hot water at a time. The steam 
allays irritation by increasing the moisture in the air of the room, 
stops coughing, and aids the action of the drugs. In the article on 
diphtheria an additional formula for such cases is also given for use 
in this manner. The drug to be used may be placed in the water in 
an ordinary teapot heated by a lamp, or gas jet, or the "croup kettle" 



Fig. 85. 




Croup kettle and inhaler. 



may be employed, (Fig. 85), or in its place the appliance shown in 
the article on Bronchitis. In other instances the apparatus shown in 
Fig. 86 may be used. In this arrangement the medicated steam is 
generated in the boiler and then escapes from the upper end of the 
tube and is inhaled by the patient, who brings his face as near the 
apparatus as the heat will permit. 



488 



REMEDIAL MEASURES OTHER THAN DRUGS. 



The foliating formula is useful in many cases of pulmonary tuber- 
culosis and bronchitis with a dry cough, if placed in such a steam 
inhaler : 

H-— Ol.pini sylvestris fgj (30.0). 

01. eucalypti f|j (30.0). 

Creosoti - f^ss (15.0).— M. 

S. — Place 1 to 3 drachms (4.0-12.0) in the water in the boiler and inhale the 
steam three or four times a day. 

Fig. 86. 




steam vaporizer. 

If there is an excess of cough, J- an ounce (15.0) of spirit of chloro- 
form may be added to the above prescription with advantage. 

In many cases of acute laryngitis the following formula is of excel- 
lent service if used in this manner: 

R. — Tine, benzoin, comp 15J (30.0). 

Menthol gr. x (0.65). 

Spt. chloroform fgss (15.0).— M. 

8. Place 1 to '_' drachms (4.0-8.0) in the water in the boiler, inhaling the 
steam from a freshly made watery mixture several times a day. 



After using steam inhalations the patient must not inhale for sev- 
eral hours the outdoor air if it is cool. 



INHALATIONS. 489 

For use with the mask or face inhaler (Fig. 87) or Denison's 

Fig. 87. 




Yeo s inhaler made of perforated zinc bound on the edges with chamois skin, and supplied 
with elastic loops to go back of the ears or around the head. On a sponge placed in the 
front of the inhaler is dropped the medicine to be inhaled. 

Inhaler (Fig. 83) the following formula is valuable in cases of chronic 
bronchitis with excessive cough : 

a 

R.— Chloroform f^ss (15.0). 

Creosoti f§ss (15.0). 

Menthol gr. x (0.65).— M. 

S. — 10 drops on the inhaler every three hours. 

Any one of these ingredients may be used alone. Sometimes where 
we wish to liquefy tenacious bronchial mucus 10 drops of iodide of 
ethyl may be also placed on the inhaler to act as a stimulant expec- 
torant. The mask or Yeo inhaler must be used almost constantly if 
it is to produce good results. 

Fig. 88. 

2 




Evans' pocket mhaler Half size The finger of the patient may be placed over the opening 
marked 1 when exhaling and over that marked 2 when inhaling. 

Small pocket inhalers loaded with medicated cotton mav be used. 
A small glass tube is partly filled with cotton, and this is kept in 



490 



REMEDIAL MEASURES OTHER THAN DRUGS. 



place by perforated corks fixed in either end. Any of the medica- 
ments named may be placed on this cotton, and the air inhaled 
through the tube. A useful tube of this sort packed with crystals 
of menthol, and called a " Menthol Inhaler," is largely sold in the 
drug stores at present. It is useful in acute colds. A useful modifi- 
cation of this straight tube is that of Evans (Fig. 88). In this ap- 
paratus the sponge in the bulb is wet with the medicament. 

Fig. 8-9. 




Robertson's nebulizer attached to a tank of compressed air. The tubes are so arranged that 
one "i- all of the medicaments in the differenl bulbs can be delivered t<> the patient at one 
time, in addition to the tube which carries the nebulized drug to the patient there is an 
extra attachment for an atomizer, which is seen <>n the right-hand Bide of the figure. 



There are on the market at the present time a large number of 
so-called vaporizers or nebulizers, which by the aid of compressed air 



INHALATIONS. 491 

force the medicine to be inhaled in a fine spray against the side of 
the glass containing it, in this manner still further comminuting it 
and causing it to escape from the bottle or bulb as an exceedingly 
fine vapor. The larger ones are supplied, as a rule, with compressed 
air from a force pump or large hand pump. The smaller ones are 
worked by a small hand pump or rubber bulb. The forms employed 
largely by the writer are those of Robertson and Oliver. (See Figs. 
89, 90.) For the satisfactory use of these nebulizers the medica- 

Fio. 90. 




Oliver's nebulizer. 

ment had better be dissolved in an oily fluid. The following formula 
may be used in such an apparatus in coryza or acute inflammation of 
the upper respiratory tract : 

R.— Menthol gr. xx (1.3). 

Camphorae gr. x (0.65). 

Arboleni (liquid) f^j (30.0).— M. 

S. — Place in the nebulizer and inhale the vapor several times a day. 

A somewhat similar formula of even greater value than this con- 
tains, in addition to the above, 2 to 5 grains (0.1-0.3) of chloretone, 
which is useful in that it is anaesthetic and sedative to the mucous 
membranes. (See article on Peppermint.) Where the inflammation 
is very severe and acute it is often well to substitute for the above 
formula the following one : 

R. — 01. sassafras gr. iij (0.2). 

01. santali TT^ v (0.3). 

Alboleni (liquid) f^j (30.0).— M. 

S. — Use in vaporizer. 

In such small amounts sandalwood oil is sedative. If we wish to 
use it as a stimulant expectorant, we can increase the quantity to 30 
minims (2.0). An even more stimulant inhalation in cases of chronic 
bronchitis is as follows : 

R.— 01. eucalvpti f^j (4.0). 

01. picis liquid f.^ij (8.0). 

Alboleni (liquid) fgj (30.0).— M. 

S. — Use in nebulizer. 



492 REMEDIAL 3IEASURES OTHER THAN DRUGS. 

INTRAVENOUS INJECTION. 

The intravenous injection of medicines is a method which is to be 
employed only under extraordinary circumstances and with only a few 
drugs. Thus in the case of snake-bite it may be advisable to resort 
to an injection of diluted aqua ammonia or ether, or even warm 
brandy or whiskey. Under these circumstances the injection should 
be made into a vein in the leg, rather than one in the arm, as the drug 
under these circumstances does not reach the heart in so concentrated 
a form and temporary cardiac depression is thereby avoided. 

The objections to intravenous injections are several. In the first 
place, the veins are apt to be collapsed and hard to find, and it is diffi- 
cult to puncture one without w r ounding the opposite wall of the vessel. 
Again, phlebitis is a very probable sequel, and thrombosis and embo- 
lism are by no means impossible. 

It is needless to say that the solution of the drug which is injected 
into a vein should always be of a neutral or alkaline reaction in order 
to avoid coagulation of the blood. (For Saline Injections, see Trans- 
fusion.) 

KATAPHORESIS. 

By the term " kataphoresis " we mean a method resorted to by 
physicians having for its purpose the introduction into the body of 
drugs through the influence of electricity. Correctly speaking, kata- 
phoresis is an osmosis of medicaments through the tissues, the 
osmosis being carried on by the galvanic current and the drug being 
carried through the tissues between the two poles. Quinine, cocaine, 
iodide of potassium, the various soluble salts of mercury, and chloro- 
form and ether may be so used. The ordinary sponge or absorbent 
cotton tip of the positive electrode is to be saturated with the medica- 
ment to be used, and the constant current employed. The positive 
pole of the battery is placed over the affected part, and the negative 
at a little distance away. 

In cases of neuralgia, chloroform and alcohol, of each one-half, or 
even pure chloroform, may be employed, and in syphilitic nodules, 
when the patient's stomach cannot bear drugs, kataphoresis with 
iodides over the part affected may be resorted to. The iodide of 
lithium is commonly employed in the strength of 5 per cent, in these 
cases. The strength of the current depends upon the size of the 
electrodes and the sensations of the patient. It is not necessary to 
use a stronger current than the patient can bear with comfort. 

LAVAGE. 

This is a term applied to washing out of the stomach in cases of 
gastric dilatation, fermentative dyspepsia, and more rarely in cases 
of Lr;ist ric, carcinoma. It is particularly valuable in the two first- 
named conditions, not merely for its curative power, but also to rid 
(lie <i<>m;icli of mucus and render it clean before fresh food is placed 
in it. 



LAVAGE. 



493 



The liquid employed should always be warmed. For an adult 
a tube should be used of at least four and a half to five feet in 
length, of which eighteen inches pass into the mouth, the remain- 



Fig. 91. 




The stomach-tube having been passed, the funnel is filled from a pitcher and elevated to urge 

the water into the viscus. 

ing portion reaching to the basin when lowered to allow siphonage. 
The question as to the variety of tube to be employed is a vital 
one, since a poorly-devised apparatus not only gives no relief, but 
disgusts both the patient and the physician with the technique of the 
method. The tube should be more like a hollow bougie than a cathe- 
ter, in order that its calibre may be great enough to carry off some 
of the semi-solid materials present. If this rule is not carried out, 
two evil results follow : In the first place, the tube and its apertures 
rapidly, or even at once, become clogged ; secondly, the liquid is 
drained away, leaving behind a mass which is semi-solid, to be sure, 
and less bulky, but which is nevertheless the quintessence of the 



494 



REMEDIAL MEASURES OTHER THAN DRUGS. 



nastiness of fermentation, and quite as qualified to leaven any fresh 
food on its entrance as the liquid would be. 

The holes in the gastric end of the tube should therefore be of suf- 
ficient size to take in fairly large masses. In some cases the ordinary 
siphon may be used, but where there is any solid food or resistance 
suction by means of a stomach-pump is necessary. 

The best tube for adults is No. 10, made of red Para rubber with 
lateral holes. 

Fig. 92. 




.hist as the last portion of the water is about to disappear down the tube the funnel end is 
Lowered and the contents of the stomach are siphoned out. 



The methods by which lavage is employed, further than those 
we have named, are as follows: The tube should be passed back- 
ward against the roof of the mouth, so that by following the curve 
of the hard and soft palates it is directed into the pharynx and 
oesophagus, and then by gentle pressure forced on down into the 
stomach. At the same time the patient should be directed to swallow. 
The mucus in the throat sufficiently lubricates the tube, and oil is to 
be avoided, [f gagging is excessive, the pharynx maybe first painted 
with cocaine. 'Hie irritability of the pharynx usually rapidly disap- 
pears, and it is surprising how quickly the patient may become accus- 
tomed to the operation, and submit to it without any feeling of dis- 



LEECHING. 495 

comfort. After the tube has reached the stomach a small funnel is 
to be fitted in its external end, which is then held above the head of 
the patient while water prepared in the way we have mentioned is 
poured into it until the stomach is filled, when the funnel end is low- 
ered and the stomach is emptied by siphonage. 

The stomach-pump has one very serious disadvantage, which is 
present with even more force in the case of a child than in an adult — 
namely, the danger of injury to the coats of the organ. This appa- 
ratus is also more costly and cumbersome, and for children the siphon 
is powerful enough in its action to take away all excuse for the use 
of the more complicated apparatus unless the contents of the stomach 
are in bulk. 

It is particularly necessary in children, if a catheter is used and 
on account of the lack of intelligent aid and their liability to gulp, 
that every care should be taken that the tube does not slip entirely 
out of reach into the stomach ; and for the prevention of this danger 
a string should be attached to the external end of the catheter before 
it is introduced, and the tube should always be at least thirty inches 
in length. 

LEECHING. 

Leeching is a method of abstracting blood for the purpose of 
relieving local inflammations or acute congestions. There are two 
forms of leech commonly employed in medicine, both of which are 
imported. A small leech is found in many streams in the United 
States. Leeches, after attaching themselves to the skin by means of 
their sucking apparatus and teeth, secrete a liquid which prevents 
coagulation of blood, and this accounts for the persistent hemorrhage 
sometimes seen after a leech-bite. 

Therapeutics. — The reasons for using venesection or depletion are 
considered further on, and we can therefore pass directly to the uses 




Showing the application of leeches in front of and behind the ear, for the relief of the early 
stages of acute otitis. The auditory meatus is plugged with cotton to prevent the leech 
from entering the canal by accident. 

to which leeches are put. In cases of meningitis they may be applied 
to the temples or to the nape of the neck, and they are useful in the 
treatment of swollen joints, such as occur after sprains. In orchitis 



496 REMEDIAL MEASURES OTHER THAN DRUGS. 

they should not be placed upon the scrotum, but on the perineum. In 
conjunctivitis or inflammation of the eye they should be applied upon 
the temple or back of the ears, not upon the lid itself. 

Application. — Leeches if singly applied may be placed on the skin 
under an inverted wineglass or under a large pill-box to prevent them 
from migrating before they take hold. If they will not take hold, a 
little sweetened milk may be placed on the skin or a drop of blood 
extracted from the finger may be placed there. In all cases the skin 
should be carefully washed before the leech is used. When the leech 
has taken enough blood, it can be made to let go its hold by sprinkling 
it with salt. Each leech will take about 1 drachm of blood. Leech- 
bites should be watched lest prolonged consecutive bleeding exhaust 
the patient. In case of such an accident a compress and styptics are 
to be employed. As leech-bites make small permanent scars, the 
creature should not be applied on the face or other exposed surface 
of the skin. 

REST CURB. 

The rest cure, so called, is a method devised and elaborated by Dr. 
S. Weir Mitchell of Philadelphia for the relief of a large class of 
patients who, for various reasons, are generally ailing from apparently 
no organic disease, and yet whose condition is often so alarming as to 
lead to the belief that some hidden cause of a severe train of symp- 
toms must be present. In many such instances a careful study of 
the case will show that there is a cause, near or remote, which has 
exhausted the patient's vital forces without producing anything else 
than functional disturbances of the body. Thus a prolonged nerve- 
strain in nursing a sick relative may so exhaust the strength of a 
hitherto healthy woman as to produce hysteria, anaemia, and great 
disturbances of nutrition, or, in another instance, cause neuralgia, 
disordered menstruation, and uterine or ovarian pain. In males 
mental, sexual, or physical vigor may be impaired, owing to pro- 
longed anxiety in business. Be the symptoms what they may, as 
long as they are dependent upon nerve-strain this " cure " is to be 
resorted to, and if properly carried out is often blessed with surpris- 
ing results. Before describing the method in detail it is proper to 
state that its entire rationale rests upon the remembrance that every 
movement is an expenditure of force, and that a system which has 
already overdrawn its reserve fund of strength must be as careful 
with its funds that remain as a bank should be under the same cir- 
cumstances. 

It having been decided that the rest cure is to be employed, the 
directions are given as follows : 

A bright, airy, easily-cleaned, and comfortable room is to be 
selected, and adjoining it, if possible, should be a smaller one for an 
attendanl or nurse. The patient is put to bed and kept there for 
from three to six weeks, as may be necessary, and during this time is 
allowed to sec no one except the nurse and the doctor, since the pres- 
ence of friends requires conversation and mental effort. The patient 



REST CUBE. 497 

in severe cases, must be fed by the nurse, in order to avoid the expend- 
iture of the force required in the movements of the arms. No sitting 
up in bed is allowed, and if any reading is done it must be done by 
the nurse, who can read aloud for an hour a day. 

In the case of women the hair should be dressed by the nurse to 
avoid any physical effort on the part of the patient. 

To take the place of ordinary exercise two measures are employed, 
the first of which is massage or rubbing of the body, the second elec- 
tricity. By the kneading and rubbing of the muscles and skin the 
liquids in the tissues are absorbed and poured into the lymph-spaces 
and a healthy blush is brought to the skin. This passive exercise is 
performed in the morning or afternoon, and should last for from, a 
half to one hour, every part of the body being kneaded, even to the 
face and scalp. In the afternoon or morning the various muscles 
should be passively exercised by electricity, each muscle being made 
to contract by the application of the poles of the battery to its motor 
points. Both these forms of exercise do not call for any expenditure 
of nerve-force, though they keep up the general nutrition. The fol- 
lowing programme for a day's existence is an example of what the 
physician should order : 

7.30 a. m. Glass of hot or cold milk, predigested, boiled, or raw 
as the case requires. 

8 a. m. The nurse is to sponge the patient with tepid water or, 
with cold and hot water alternately, to stimulate the skin and circu- 
lation, the body being well wrapped in a blanket, except the leg or 
portion which is being bathed. After this the nurse should dry the 
part last wetted with a rough towel, using some friction to stimulate 
the skin. 

8.30 A. M. Breakfast. Boiled, poached, or scrambled eggs, milk 
toast, water toast, or a finely-cut piece of a mutton-chop or chicken. 

10 a. M. Massage. 

11 A. M. A glass of milk, or a milk-punch, or egg-nog. 

12 M. Reading for an hour. 

1 p. M. Dinner. Small piece of steak, rare roast beef, consomme 
soup, mutton broth, and any one of the easily-digested vegetables 
well cooked. 

3 p. M. Electricity. 

4.30 p. m. A glass of milk, or milk-punch, or egg-nog. 

6.30 p. m. Supper. This should be very plain, no tea or coffee, but 
toast and butter, milk, curds and whey, or a plain custard. 

9.30 p. m. A glass of milk or milk-punch. 

In this way the day is well filled, and the time does not drag so 
heavily as would be thought. If the stomach rebels at over-feeding, 
the amounts of food must be cut down, but when all the effort of the 
body is concentrated on respiration, circulation, and digestion a large 
amount of nourishment can be assimilated by the exhausted body, 
which before this treatment is undertaken may have had its resources, so 
shattered as to be unable to carry out any physiological act perfectly. 

For the treatment to be successful tile rules laid down should be 
rigidly followed and never remitted for a single hour, 

32 



498 REMEDIAL MEASURES OTHER THAN DRUGS. 

MINERAL SPRINGS AND CLIMATE. 

This article is intended to give the practitioner and student a gen- 
eral idea of where to send patients who can afford to resort to treat- 
ment depending upon watering-places and climates. It is manifestly 
impossible to include the names of all the health-resorts, and the 
object has been to indicate the diseases which are benefited by these 
treatments, taking certain well-known resorts as types of each class. 

Spring's. 

Medicinal springs are usually resorted to for the double purpose 
of drinking and bathing in the waters, although in many instances 
one of these methods so far exceeds the other in popularity that it 
alone is employed. 

For general purposes we may divide these medicinal or beneficial 
waters into four classes — namely, those which act, first, by their 
purity chiefly ; second, by the presence of more or less active alkaline 
ingredients ; third, by the heat which the waters contain as they 
leave the earth ; and, fourth, by reason of the sulphur and iron which 
they contain. The first class — namely, those which act by reason of 
their purity — are indicated chiefly in cases where through high living 
or other cause the system becomes laden with impurities through 
imperfect elimination of tissue-waste. Most of the popular lithia 
waters depend chiefly upon this ability to dissolve effete materials, 
and very little upon the lithia, which is often present in very small 
amount. (See Lithium.) Aside from their purity, they also act by 
reason of the salts of sodium and calcium which they contain. Good 
results follow their use in the so-called uric-acid diathesis where the urine 
is scanty, high-colored, and acid. They do good in cases of irritable 
bladder by washing out this viscus with mild urine in large quantities, 
and because of this influence are credited with wonderful cures of 
vesical calculus. When vesical calculi have broken down while these 
waters were being taken, the fortunate result has been coincidence 
rather than medicinal interference. It is impossible for them to dis- 
solve stones, but their constant use may prevent the formation of new 
ones. Perhaps the best representative of such waters is Londonderry 
lithia water. 

A subdivision of this class consists of those waters which contain 
somewhat larger amounts of mineral substances, chiefly potassium, 
sodium, and calcium salts. Because of the power possessed by alka- 
line salts in aiding in oxidation, these waters are used in cases where 
the effete matters of the body seem to escape only partly oxidized, and 
where the kidneys, and perhaps the liver, seem torpid. Such springs 
are the Kissingen and Vichy at Saratoga. If very mild purgative prop- 
erties are also desired, the Geyser Spring at Saratoga may be used. In 
Europe the most famous springs of this class are at Vichy (Grande 
Grille), Yals. and Contrexeville in France, and Kissingen in Bavaria. 

The second class of Springs are those which contain salts of sodium, 
calcium, potassium, and magnesium in sufficient amount to possess 



MINERAL SPRINGS AND CLIMATE. 499 

very active diuretic and purgative properties. They find their thera- 
peutic application in cases of hepatic torpor or congestion associated 
with gouty or rheumatic tendencies, particularly in those individuals 
who have been high livers, who lay on too much fat, so clogging their 
organs, and, finally, in those who through illness or exposure to hot 
climates have subacute or chronic atony of the liver, of the organs 
of digestion, and of the lymphatics. Nearly always these patients 
also suffer from more or less constipation and gastro-intestinal catarrh, 
and are often obese. The sulphate of sodium is an ingredient of 
many purgative mineral waters, and the activity of a water depends 
very often on the percentage of this salt which is present. The pur- 
gative action of a water also depends upon the time at which it is 
taken. When taken on an empty stomach it is of course more active. 
When taken early in the morning before eating and at the natural 
temperature such a water produces a loose watery movement, not 
only unloading the bowel of faecal matter, but by its alkalinity loosen- 
ing catarrhal secretions and unloading the liver of congestion. The 
quantity to be taken in twenty-four hours varies from 1 to 4 pints, 
but this question can only be decided by the local physician, who 
studies the effect of the water on the patient. The best-known waters 
of this class are the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga, New York, the Crab Orchard in Kentucky, and 
the springs of Carlsbad and Marienbad in Bohemia, and Friederich- 
shall in Germany. 

The hot springs depend chiefly on their heat, as already stated, 
and differ in chemical composition. They find their value in the 
treatment of chronic skin diseases, specific or otherwise, and also are 
useful in aiding in the treatment of rheumatism, gout, and syphilis. 
Their good results are produced by their heat, which varies from 
93° F. to 150° F., and the advantages always derived from properly 
employed hydrotherapeutic measures. It is in chronic or subacute 
cases that they do the most good. Hot baths are also of great value 
in the treatment of chancroid and malignant syphilis. The results 
achieved depend upon the increased activity of the skin, the improve- 
ment of the peripheral circulation, and the increased powers of absorp- 
tion produced through increased cellular activity. 

Patients should always select a competent local physician at such 
places. 

In cases of syphilis the methods of treatment to be followed are as 
follows: The patient should take the bath at a temperature of 90° F., 
and remain in it for about twenty minutes. After this he is rapidly 
but thoroughly dried by an attendant, who at once proceeds to rub into 
the s,kin of one thigh an amount of mercurial ointment varying from a 
few grains to a drachm. This is well rubbed into, not smeared over, 
the skin of a different limb after each bath. The number of baths and 
inunctions depends upon the condition and necessities of the case, 
care being exercised not to push the mercury too freely in those who 
are very susceptible to its use. These baths also aid in the absorp- 
tion of mercury when it is administered by fumigation. 



500 REMEDIAL MEASURES OTHER THAN DRUGS. 

The most celebrated of these springs are the Hot Springs of 
Arkansas and those found at Aix-la-Chapelle (Aachen) in Germany. 

As types of the fourth class of springs we have the White Sulphur 
Springs in West Virginia and the Richfield Springs in New York, 
which are used for the relief of catarrhal inflammations of the mucous 
membranes of the alimentary canal and respiratory passages, and 
more rarely for catarrhal states of the genito-urinary tract. Not 
only do they exert the peculiar remedial powers long known to belong 
to sulphur and its compounds by reason of the sulphuretted hydrogen 
gas contained in them, but they also possess distinct purgative effects. 
Their chief mineral constituents consist of sulphate of sodium and 
magnesium, which unload the bowels and portal system in the same 
manner as do the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga and those at Crab Orchard. Taking the White 
Sulphur as a type of its class, it is better than the Saratoga springs 
in catarrhal states for the reasons given. 

Rockbridge Alum Spring in Virginia is used in cases of chronic 
diarrhoea with very useful results in many cases. It is not so useful 
in acute inflammations of the intestine as in the diarrhoea due to 
chronic disorder. As iron is present in it and in most alum springs 
in considerable amount, this water is useful in anaemic cases, but is 
contraindicated by fevers, by chronic congestions, chiefly of the liver, 
and by plethora. Often in place of alum we find salines associated 
with the iron, and these waters are particularly indicated in the 
catarrhs associated with anaemia. Such a spring exists at Bedford, 
Pennsylvania. In Europe the chief iron springs are at St. Moritz in 
Switzerland and Tunbridge Wells in England. Neither of these 
contains much sulphur or alum. 

Climates. 

The practitioner is most frequently consulted as to the possible 
benefit of climatic changes by persons suffering from pulmonary dis- 
ease, such as tuberculosis of the lungs, asthma, chronic bronchitis, 
and emphysema — more rarely by those convalescing from pneumonia 
or other severe acute illness. 

The general rules to be followed in all cases are — first, choose 
a climate having as large a number of clear days as possible, in 
order that an out-of-door life in the sunshine may be had constantly; 
secondly, the nearest place to the home which is available in order to 
avoid fatigue, expense, and home-sickness; and thirdly, see that the 
resort chosen has comfortable accommodations, good food, good drug- 
Supplies, and ;i capable physician at hand in ease of need. 

In a ease of tuberculosis and in all patients suffering from the pul- 
monary complaints named above the following rules may be adhered to, 
except in persons suffering from attacks of acute bronchitis, who always 
need a climate providing moisture and warmth. Some tubercular 
patients do best in a high, dry air, and others in a lower and more 
moist temperatun — the first being represented by that of Colorado 
Springs (6000 feet) in America and by San Moritz (6000 feet) and 



MINERAL SPRINGS AND CLIMATE. 501 

Davos Platz (5000 feet) in Switzerland, where the altitude is not 
only very great, but the air very cold in winter. The days in these 
places are many of them clear, but in Colorado they are apt to be 
windy. Feeble persons cannot stand high winds, as a rule. The 
second climate is represented by that of Florida. 

In many cases, however, some more moderate climate is useful, and 
this can be obtained in Southern California, as at San Diego, a place 
where there is virtually perpetual summer, or at Asheville, N. C. (2200 
feet), or Thomasville, Georgia (330 feet), where the air is moderately 
dry. In other words, a spot is desirable where a patient can remain 
the year round, and, if well enough, engage in business, avoiding the 
cold, sharp March winds of the Middle, Eastern, or North-western 
States, and the necessity of leaving Florida on the advent of summer. 

Physicians have attempted for years to formulate rules for phthis- 
ical patients as to the climate to be sought. In very many cases the 
various health-resorts have to be chosen by experiment, not by judg- 
ment beforehand. In cases of phthisis with profuse bronchial secre- 

Fig. 94. 




Chest outline before residence at Davos . After residence at Davos (Williams' 

diagram.) 

tion a high, dry climate is generally the better unless the heart is 
feeble, but in cases which suffer from dryness of the air-passages a 
sea-voyage or a warm, moist climate is better, on general principles. 
It is probably true, however, that high altitudes and rarefied air are 
not to be sought where a distinct tendency to hemorrhage is present, 
unless the ascent or removal to the rarefied air is very gradual, several 
weeks being passed before the lung is exposed to the low pressure of 
great heights. The cases in which high altitudes do good are those 
which naturally have poor thoracic development or suffer from chronic 
pleurisy with deficient expansion of the lung after tapping. The 
following excellent advice given by White in his General Thera- 
peutics, is worthy of repetition : 



502 REMEDIAL MEASURES OTHER THAN DRUGS. 

"It is of such importance that only suitable cases should be sent 
to high altitudes that we must point out those that are unsuitable : 

" 1. Those in whom there is considerable affection of the bronchial 
tubes, for the dryness of the climate increases the kind of bronchitis 
which commonly accompanies phthisis. 

" 2. Patients with much emphysema or bronchiectasis, because of 
the probably diminished absorption of oxygen and the difficulty of 
respiration experienced on first arriving. 

" 3. Patients with disease of the heart must not go to a high alti- 
tude, because of its effect upon the pulse and upon respiration. 

tw 4. Cases liable to acute febrile attacks, whether or not these 
indicate an occasional increase of mischief in the lungs, should 
remain on a low level. 

"5. Patients who are very excitable or suffer from insomnia 
should not go, for a visit to a place at a great elevation promotes 
these symptoms. Women do not acclimatize so well as men. 

" 6. Cases in which there are very extensive lesions, or which are 
very advanced, are unsuitable. 

" Pneumonic phthisis, if at all acute, is made worse by a high 
altitude. 

" 8. Patients who cannot take exercise should not go. 

"9. The very old and the very young had better be treated at 
home. 

" 10. Sir Andrew Clark (London Lancet, January 5, 1889) states 
that patients who go to Alpine health-resorts suffering from albumin- 
uria, or those who develop it whilst there, seldom derive any good 
from their change. 

" There are many conditions which have been thought to contra- 
indicate this treatment, but which do not, and they had therefore 
better be mentioned. They are — 

"Pulmonary Hemorrhage. — It is now known that this, so 
far from being a contraindication to treatment by high altitudes, is 
actually relieved by it. The exact explanation cannot be given." 

With this the author of this book cannot agree. 

" Fever. — If this is not excessive, and if it does not indicate any 
active changes in the lungs, it is often improved. 

" Simple Diarrhoea and Simple Dyspepsia. — These are both 
benefited. 

" Night-sweats. — There is a common belief that these forbid this 
treatment ; on the contrary, they often disappear on removal to a high 
altitude. 

"The Presence of Cavities. — This is not a contraindication, 
unless a very large area of lung is destroyed. 

tl There is no need, after these two lists, to say what cases are suit- 
able \'<>r this climatic treatment: it may, however, be observed that 
those in which there is threatened phthisis, with a strong hereditary 
predisposition, and those of imperfect thoracic development, are much 
benefited. According to most authorities, it cannot be too strongly 
urged thai so long as the condition and disease! of the patient allow the 
reverse indications to be neglected a mountain climate should be tried. 



SUSPENSION. 503 

To these rules the author would add the following invariable rule : 
viz. Do not send a case away to die. If the disease is so far advanced 
that no good can be derived from a trip abroad, it is cruel to make a 
wretched patient exhaust his strength, his money, and his happiness 
by seeking health which it is impossible for him to obtain. A patient 
of the writer's returned on one occasion from a stay of a few days at 
a noted Southern resort for consumptives, and, when reprimanded for 
his imprudence, replied: "Doctor, I would rather be at home, and 
die at once, than drag out a few more years surrounded by a crowd 
of coughing, hawking, and wasting consumptives." This reply evi- 
dences clearly the necessity of avoiding " consumptive resorts " as 
much as possible in these cases, and in directing the mind of the 
patient from depressing thoughts and his own ailment, and that he 
may avoid secondary infection from other sufferers. 

In the treatment of renal and cardiac disease high altitudes are 
contraindicated as a rule. The chief desideratum is out-of-door life, 
with avoidance of chilling of the skin by sudden changes in tempera- 
ture or strong winds. San Diego represents the necessary climate in 
such cases. 

There is a class of persons who often have no actual disease of a 
chronic type, who nevertheless pass healthier lives if away from rig- 
orous climates for at least part of the year. Without having acquired 
tuberculosis, their lungs are delicate naturally or because of attacks 
of disease, or, again, they become asthmatic or rheumatic in cold 
weather. In this country Asheville, N. C, and Thomasville, Ga., or 
San Diego or Coronado Beach, California, afford the climate desired, 
while in Europe patients are sent to what is known as the " Riviera," 
which is the district bordering on the Mediterranean Sea from Genoa 
to Nice and which is dotted with climatic resorts. This district has 
often as many as two hundred clear days between October 1st and 
May 1st. In the French Riviera the resorts are Cannes, Nice, 
Monaco, Monte Carlo, and Mentone ; in the Italian Riviera, Bordi- 
ghera and San Remo. In Naples and Spezzia the climate is more 
damp and colder, but nevertheless quite sunny. So much depends 
upon the location of the hotels in these places, as far as their salubrity 
in relation to air and dampness is concerned, that the patient should 
always consult a local physician before settling down permanently at 
any of these resorts. 

SUSPENSION. 

The treatment of locomotor ataxia and allied affections by means 
of suspending the patient has, during the last few years, been found 
so valuable for the relief of symptoms as to have taken a permanent 
place in therapeutics. The method is not confined to cases depend- 
ing upon diseases of the vertebrae producing lesions in the spinal cord, 
but is equally useful in instances where the lesion is primarily situated 
in the nervous tissues. The pain, nervous shootings, and tinglings, 
as well as the muscular contractions, which often trouble the patient 
very greatly, are all relieved, and in some cases walking is possible 



504 REMEDIAL MEASURES OTHER THAN DRUGS. 

where, before the treatment, crutches were entirely relied upon. The 
knee-jerk, when absent or excessive, tends to return to the normal 
state, and the bladder and rectum become more regular in their 
functions. 

The patient should use one of the apparatuses made by most large 
surgical-instrument makers, which consists in a cushioned head-strap 
and a cushioned leather loop for each axilla. The traction on the 
head should not be sufficient to cause discomfort ; in other words, the 
weight of the patient should be equally distributed between the shoul- 
ders and the head. A rope is run from the harness to a pulley in the 
ceiling, and by this means the patient may be slightly raised from his 
chair — say two inches — once a day, for thirty seconds at first, which 
may gradually be increased to ten minutes. The swinging should be 
resorted to at first every second or third, and finally every, day. If 
several pulleys are put in the circuit of rope the patient can soon 
learn to lift himself, making the rope fast to a cleat in a heavy chair 
or table, or even holding it in the hands. It is important that the 
patient after each swinging should rest for thirty minutes to an hour, 
and when let down to his chair the movement should be most gentle 
and not jerking or sudden. The same rule as to gentleness applies to 
the raising of the patient. 

TRANSFUSION. 

The term Transfusion was originally applied in medicine to the 
transference of blood from a healthy person (the donor) to the sick 
patient (the receiver), who was usually suffering from the results of 
profuse hemorrhage. When direct transfusion was not resorted to the 
blood was defibrinated after being drawn from the arm of the donor 
and the serum injected into the vein of the sick man. Both of these 
plans are now practically obsolete, for it has been proved that the 
blood-corpuscles of the donor always die in the vessels of the receiver 
and the kidneys are overwhelmed in an effort to eliminate the results 
of their destruction. Further, it is almost impossible to perform trans- 
fusion of pure or defibrinated blood without producing clots which will 
form emboli in the vessels of the patient. Finally, we now know that 
the blood-serum of one man differs greatly from that of another in its 
physiological effects and is not to be regarded as identical with the 
serum that is lacking in the patient, The use of milk as a transfusion 
fluid has been found to result in albuminuria, in infections of various 
kinds, and in the development of emboli. It ought never to be used 
for this purpose. 

At the present time the profession employ a saline solution, injected 
L'ontly into a vein of the arm or leg, not only to overcome the collapse 
of hemorrhage, but — far more important — for the relief of various 
forms of toxaemia. Commonly in hemorrhage and in toxaemia hypo- 
dermoclysis is used, as already described, because the danger of embo- 
lism and the possible results of opening a vein are not to he disregarded. 
Therefore, while hypodermoclysis is the safest and preferable method 
ordinarily, on the other hand when the case is very urgent, or the 



TRANSFUSION. 505 

tissues are oedematous from dropsy, or the circulation is so feeble that 
absorption is impossible, then the intra- or endo-venous injection is to 
be employed without hesitation. 

Various formula exist for the preparation of the so-called normal 
saline solution. Some persons are satisfied to employ the ordinary 
solution of common salt in the strength of -^ of 1 per cent. (1-^- 
drachms to the quart), in distilled and sterilized water. Others prefer 
to use a formula suggested by the well-known French clinician Prof. 
Hay em, as follows : 



oo~ 



Sodium sulphate 10.0 

Sodium chloride 5.0 

Distilled water 1000 c.cm. 

A still better solution, however — because it at once supplants the 
blood which has been lost or is impure, and because it supports the 
heart, is — 

Calcium chloride 0.25 

Potassium chloride 0.1 

Sodium chloride 9.0 

Sterilized water 1000 cc. 

At the author's suggestion, there is now placed upon the market a 
concentrated saline solution in wmich the salts just named are dissolved 
in one ounce of sterile water and placed in a sealed sterile bottle. The 
contents of one of these vials added to 1 quart (1000 cc.) of pure sterile 
water make a normal saline fluid ready for instant use. 

The method of injection is as follows: The thoroughly sterilized 
saline solution, after being warmed to the temperature of 101° F., is 
placed in a warm glass irrigation-flask. The patient's skin over the 
elbow is bared and sterilized ; the skin over one of the veins, which is 
made prominent by a bandage about the upper arm, is incised by a 
scalpel, and the sheath of the vein raised by means of a pair of dis- 
secting forceps. This sheath is thoroughly dissected off the vein until 
this vessel lies free of any attachments for the space of half an inch. 
A small and gentle bull-dog clip is applied on the vein at the proximal 
end of the incision so as to keep the lower part of the vein full of 
blood. A ligature is now passed around the vein at the distal end of 
the incision and tied. Another ligature is then passed under the vein 
and left untied. The distended area of the vein, between the ligature 
which has been tied and the clip, is now snipped by means of a pair 
of fine scissors ; and a glass canula, previously dipped in the saline 
solution to prevent the few drops of blood from coagulating on its tip, 
is inserted into the opening in the vein. The loose ligature is now tied 
around it and the vein, to hold the canula in place. This canula 
should have a shoulder at its tip to prevent the ligature from slipping 
off, and its other end should be attached to a piece of sterile rubber 
tubing not more than four inches long. By means of a sterilized glass 
pipette some of the saline is now run into the rubber and glass canula 
until all air is displaced and they are filled to the utmost. The saline 
is then allowed to flow out of the tubing attached to the irrigator, 



506 



FEME DIAL MEASURES OTHER THAN DRUGS. 



which is armed by a glass tip, till all the air is displaced, when 
one tube is slipped inside the other. By this means all danger of 
air-embolism is excluded. The irrigator is now held about two feet 
above the arm and the fluid allowed to slowly enter the vein, a half 
hour being spent in injecting about a quart. (Fig. 95.) As the injec- 



Fig. 95. 





Apparatus used for intravenous injection of saline solution. An ordinary glass irrigator has 

placed in it a glass runnel, tlu' stem of which is dilated for the holding of some absorbent 
COtton. The sterile saline solution is formed in the funnel, and all foreign bodies filtered 
out by the cotton as the fluid runs into the glass container, which is graduated in half litres 
or pints. The flow ofliquid in the nil- her tube leading fnun the container is controlled by 
a clip. The pipette and vein canula are also shown. By the use of the glass tubes air em- 
boli can i»e seen and displaced. 



tion is given the pulse begins to improve, the respirations are deeper 
and less hurried, and if fever is present the temperature usually falls. 
The patient is evidently better, but soon enters the critical stage, which 
may come on in from two to thirty minutes. There is often a violent 
chill, a strong rapid pulse, and in the course of three-quarters of an 



VENESECTION. 507 

hour a flushing of the skin followed by a profuse sweat. The respira- 
tion may be labored. The kidneys also increase the urinary flow and 
sometimes water escapes from the bowel. Several hours later the real 
benefit appears in convalescence or marked improvement. 

The conditions in which the intravenous injections are to be per- 
formed are severe hemorrhage, toxcemia arising from the various forms 
of infection, as in septicemia, uraemia, and the comatose state in diabetes 
mellitus. They can be employed in threatened eclampsia, and even in 
the toxaemias of the infectious fevers. 

The author has used them in ursemic and septic intoxication with 
the best results. The principle of this treatment is that it causes the 
rapid elimination of impurities from the body. 

This method is to be regarded as a fairly promising method of treat- 
ment for cases otherwise doomed to death, and will afford permanent or 
temporary relief according to the severity of the underlying disease. 
When diabetes exists or Bright's disease is present the benefit is often 
only temporary. The European clinicians are loud in their praises of 
the results they have obtained by this plan in the various forms of 
sepsis. In uraemia the patient should be bled if the arterial tension 
is high. 

Abdominal transfusion of both saline solutions and milk have been 
successfully carried out, the reason being that the peritoneal cavity is 
a vast absorbent surface which rapidly takes up liquids if the systemic 
vessels are not as full as they normally should be. The method con- 
sists in puncturing the abdominal wall as if for aspiration for dropsy. 
The tube from a hydrostatic syringe is now attached to the canula, 
and the liquid, having been warmed, is allowed to slowly flow into 
the belly. This method is not to be relied on where death seems 
very imminent, and the use of milk is dangerous. There is also some 
danger of perforating the bowel wall. 



VENESECTION. 

Bleeding, or Phlebotomy, is so rarely practised to-day that very 
many of the profession have never abstracted blood for therapeutic 
purposes or have even seen it done by some one else. Furthermore, 
it is to be feared that many of the younger physicians would hardly 
know how to bleed if called upon to do so at a crisis. All this is 
wrong, for bleeding is a measure undoubtedly of the greatest value 
and one which every one may be called upon to resort to. Like many 
therapeutic measures, it was sadly abused in the early part of this cen- 
tury, and people were bled when taken ill with the same regularity 
that they were put to bed. 

The indications for venesection are as clear and well defined as are 
the indications for any remedy. Briefly stated, we may say that all 
states of the circulatory apparatus denoting high arterial tension and 
excitement are indications, and that weakness, low arterial tension, 
and systemic or circulatory depression are contraindications. Since the 
use of veratrum viride has become more common, the conditions indi- 



508 REMEDIAL MEASURES OTHER THAN DRUGS. 

eating venesection have been lost sight of, because this drug so dilates 
the blood-paths that a man is bled into his own blood-vessels. 

Having made clear the general indications for the use of venesec- 
tion, we may pass on to state some of the diseases in which it may be 
well resorted to. Of these, pneumonia, pleurisy, meningitis, and peri- 
tonitis, if they are sthenic, are typical examples, since all of them 
are accompanied by arterial excitement and characterized by local 
congestions affecting the lung, pleura, cerebral membranes, or peri- 
toneum. (See Pneumonia.) By the abstraction of blood the vascular 
tension is lowered and the engorged area relieved. In the first place, 
the congested area is made up of relaxed blood-vessels, whereas the 
remaining blood-vessels of the body are tense, and, as a consequence, 
the blood is urged to the spot already engorged. In the second place, 
the abstraction of blood from the tense blood-vessels renders the gen- 
eral pressure lower than that in the diseased area, and the congestion 
is relieved. 

In apoplexy the extravasation of blood into the brain causes great 
arterial excitement, as a general rule, and this in turn results in 
increased intracranial hemorrhage. Bleeding is therefore strongly 
indicated, not only to prevent inflammation, but also to prevent fur- 
ther leakage into the brain-substance. 

The method by which venesection is practised is yet to be described. 
It is a very simple operation if an assistant is present to make pres- 
sure on the vein or entire arm. Often this pressure is best exercised" 
by means of a handkerchief or bandage tightly twisted about the 
arm above the spot where the incision is to be made. Under these 
circumstances the veins of the arm become prominent and distended, 
and one of them may be readily bared by a short longitudinal incision 
of half an inch, the fascia being separated until the glistening blue 
surface of the vessel appears free from fat or connective tissue. Into 
this vessel, with the edge of the knife turned upward, a small longi- 
tudinal incision is made, care being taken that the point of the blade 
is not driven in far enough to injure the posterior wall of the vein, 
or a pair of scissors is used and the vessel is nipped. If a clot forms 
and stops the flow, it must be removed by an aseptic cloth, while if 
the flow is to be stopped we may remove the bandage above and apply 
a compress over the incised vein, the compress being held in posi- 
tion by a bandage. Care should always be taken that the bandage 
on the upper part of the arm is not so tight as to cut off all blood- 
supply to the arteries of the limb. 



FEEDING THE SICK. 



In the opening pages of this book the importance of properly 
feeding the sick has already been emphasized. It is manifestly 
impossible for the writer to go into details concerning the deep and 
difficult problems of the changes in the food when taken into the 
body for assimilation. At this point it is necessary only to recall 
that the foods taken by man consist in proteids, carbohydrates 
and hydrocarbons. In the albuminous or proteid articles of food 
nitrogen is a prominent constituent, and the type is egg-albumin. 
While most nitrogenous foods are animal in source, it must not be 
forgotten that gluten and legumen are nitrogenous and derived from 
vegetables. The carbohydrates consist of substances in which carbon, 
hydrogen, and oxygen are combined, the hydrogen and the oxygen 
in the proportion to form water, of which the types are starch, dex- 
trin, cane-sugar, grape-sugar, lactose or milk-sugar. The hydro- 
carbons are composed of carbon, hydrogen, and oxygen, but the 
proportion of oxygen is insufficient to convert all the hydrogen into 
water. The types of this group are butter and other fats. 

The function of the proteid, or albuminous, foods is to contribute to 
the repair and formation of the body-tissues, particularly those which 
are nitrogenous ; they also contribute to the development of mus- 
cular and nervous energy and the production of heat, being split 
up into nitrogenous and non-nitrogenous parts, from the last of 
which fat may be formed and deposited or burnt up in the develop- 
ment of force. 

The carbohydrates are split up in the body into carbonic acid and 
water, and in this process yield heat and energy. Unlike the proteids, 
they do not enter the tissues of the body unless it be that they are 
converted into fat. By reason of the heat and energy which they 
contribute to the economy they protect the albumins and fats from 
demands which would otherwise be made upon them for these pur- 
poses. 

The hydrocarbons, or fats, are employed in the body to yield force 
and heat and to be stored up in the form of fat, so as to act as a reserve 
in case of need, so that by their use the albuminous portions of the 
body are saved from demands upon them. For these reasons hydro- 
carbons and carbohydrates can be well taken in large quantities by 

509 



510 FEEDING THE SICK. 

those who take much exercise, but are harmful if partaken of largely 
by persons leading sedentary lives. 

It is manifest, therefore, that for the maintenance of health we 
must provide a patient not with nitrogenous or carbohydrate foods 
alone, but with some of all the food articles, regulating the proportions 
of each to his needs and his ability to utilize them after they are 
ingested. 

The practical application of these facts is as follows : 

In fevers, in which there is an active wasting of the tissues of the 
body, we give albuminous foods to replace the tissues destroyed or co 
make up for their loss, and these consist of broths, soups, eggs, milk, 
and the gelatinous substances which, while not very nutritive, are 
what are known as u albumin-sparing " substances. As the secretion 
of the gastric juice is faulty in nearly all fevers, it is important to 
give these foods in semiliquid or liquid form, so that they can be 
readily digested, and we often aid their digestion by the use of pepsin 
and hydrochloric acid. 

As carbohydrates and hydrocarbons add force or energy to the 
body, and in their combustion protect the albuminous tissues, they 
also must be used, particularly the former. There is no doubt that 
physicians are far too prone to limit the patient's diet to proteids, 
and in the author's practice he invariably prescribes, in addition to 
the proteid foods, thin preparations of starch, such as strained rice, 
strained oatmeal, cracked wheat and barley, aiding their digestion, if 
need be, with taka-diastase or pancreatin. 

In order that an approximate idea of the proportion of food-stuffs 
may be conveyed to the reader, it maybe pointed out that the healthy 
human body must be provided in twenty-four hours with that amount 
of food which will yield his body 3650 calories. 1 This is best accom- 
plished by the use of the following proportions, according to Egleston : 
Carbohydrates, 400 grammes; fats, 150 grammes; proteids, 150 
grammes. Nearly all food-stuffs contain the several classes of proteids, 
carbohydrates, and hydrocarbons in varying proportions. These are 
shown in the following table, taken from Billings's Medical Dictionary, 
and it also shows the number of calories in each pound of the material. 
It is interesting to note how many more calories are provided by the 
hydrocarbons and fats than by the proteids, but it is also worthy of 
note that the proteids, while not providing calories, do provide the 
materials which are useful for the repair and growth of tissue : 

1 A calorie is the French unit of heat, or that amount of heat required to raise 
the temperature of one kilogram of water one degree Centigrade. 



FEEDING THE SICK. 



511 



Percentages of Nutrients {Nutritive Ingredients), Water, etc., and Estimated Potential 
Energy {Fuel-value) in Specimens of Food-materials. 









Edible Portion. 






Nutrients. 


Calories 




Refuse : 
bones, 






of poten- 


Food-materials. 












tial en- 




skin, 














ergy in 




shell, etc. 


Water. 












one 








Total. 


Pro- 
tein. 


Fats. 


Carbo- 
hydrates. 


Mineral 

matters. 


pound 

of each 

material. 


Animal foods as purchased, 


















including edible portion 


















and refuse : 


pr. ct. 


pr. ct. 


pr. ct. 


fpr.ct. 


pr. ct. 


pr. ct. 


pr. ct. 




Beef, side * 


19.7 


44.0 


36.3 


13.8 


21.7 




0.8 


1170 


Beef, round 1 . 




10.0 


60.0 


30.0 


20.7 


8.1 




1.2 


725 


Beef, neck 1 . 




19.9 


49.6 


30.5 


15.4 


14.3 








0.8 


890 


Beef, sirloin 1 




25.0 


45.0 


30.0 


15.0 


14.3 








0.7 


885 


Beef, flank l . 




11.7 


24.2 


64.1 


10.6 


52.9 








0.6 


2430 


Mutton, side 1 




20.0 


42.9 


37.1 


13.2 


23.2 








0.7 


1225 


Mutton, leg 1 




18.4 


50.4 


31.2 


15.0 


15.5 








0.7 


935 


Mutton, shoulder 1 . . 


16.8 


48.7 


34.5 


15.0 


18.7 








0.8 


1070 


Mutton, loin (chops) 1 . 


16.3 


41.3 


42.4 


12.5 


29.3 








0.6 


1470 


Smoked ham .... 


14.0 


36.3 


49.7 


14.6 


34.2 








0.9 


1715 


Pork, very fat ... . 


10.4 


9.5 


80.1 


2.8 


76.5 








0.8 


3280 


Chicken 2 


41.6 


42.2 


16.2 


14.2 


1.2 








0.8 


315 


Turkey 


35.4 


42.8 


21.8 


15.4 


5.6 








0.8 


525 


Flounder, whole . . . 


66.8 


27.2 


6.0 


5.2 


0.3 








0.5 


110 


Haddock, dressed . . 


51.0 


40.0 


9.0 


8.2 


0.2 








0.6 


160 


Bluefish, dressed . . . 


48.6 


40.3 


11.1 


9.8 


0.6 








0.7 


210 


Brook trout, whole . . 


48.1 


40.4 


11.5 


9.8 


1.1 








0.6 


230 


Codfish, dressed . . . 


29.9 


58.5 


11.6 


10.6 


0.2 








0.8 


205 


Whitefish, whole . . . 


53.5 


32.5 


14.0 


10.3 


3.0 








0.7 


320 


Shad, whole 


50.1 


35.2 


14.7 


9.2 


4.8 








0.7 


375 


Turbot, whole .... 


47.7 


37.3 


15.0 


6.8 


7.5 








0.7 


445 


Mackerel, fat, whole . 


33.8 


42.4 


23.8 


12.1 


10.7 








1.0 


675 


Mackerel, lean, whole . 


38.3 


48.5 


13.2 


11.2 


1.4 








0.6 


265 


Mackerel, average,whole 


44.6 


40.4 


15.0 


10.0 


4.3 








0.7 


365 


Halibut, dressed . . . 


17.7 


61.9 


20.4 


15.1 


4.4 








0.9 


465 


Salmon, whole .... 


35.3 


40.6 


24.1 


14.3 


8.8 








1.0 


635 


Eel 


36.0 
42.1 
50.9 


33.8 
40.3 
19.2 


30.2 
17.6 
29.9 


8.6 
16.0 
20.2 


21.0 
0.4 

8.8 








0.6 
1.2 
0.9 


1045 


Salt codfish 


315 


Smoked herring . . . 


745 


Salt mackerel .... 


40.4 


28.1 


31.5 


14.7 


15.1 








1.7 


910 


Canned salmon .... 


4.9 


59.3 


35.8 


19.3 


15.3 








1.2 


1005 


Canned sardines [. . . 


5.0 


53.6 


41.4 


24.0 


12.1 








5.3 


955 


Lobsters 


62.1 


31.0 


6.9 


5.5 


0.7 


0.1 


0.6 


135 


Oysters in shell . . . 


82.3 


15.4 


2.3 


1.1 


0.2 


0.6 


0.4 


40 


Hen's ess's 


13.7 


63.1 


23.2 


11.8 


10.2 


0.4 


0.8 


655 


Animal foods, edible portion: 


















Beef, side 1 . . . . . 




54.7 


45.3 


17.2 


27.1 




1.0 


1465 


Beef, round 1 .... 




66.7 


33.3 


23.0 


9.0 








1.3 


805 


Beef, sirloin 1 .... 




60.0 


40.0 


20.0 


19.0 








1.0 


1175 


Mutton, side 1 .... 




45.9 


54.1 


14.7 


38.7 








0.7 


1905 


Mutton, leg 1 .... 




61.8 


38.2 


18.3 


19.0 








0.9 


1140 


Mutton, loin (chops) 1 . 




49.3 


50.7 


15.0 


35.0 








0.7 


1755 


Flounder 




84.2 


15.8 


13.8 


0.7 








1.3 


285 


Codfish 




82.6 


17.4 


15.8 


0.4 








1.2 


310 


Mackerel, fat .... 




64.0 


36.0 


18.2 


16.3 








1.5 


1025 


Mackerel, lean .... 


. . 


78.7 


21.3 


18.1 


2.2 








1.0 


430 


Mackerel, a vera 


ge . . 




71.6 


28.4 


18.8 


8.2 








1.4 


695 



1 From well-fattened animals. 



2 Rather lean. 



512 



FEEDING THE SICK. 



FOOD-MATERIALS. 



Refuse : 
bones, 
skin, 

shell, etc. 



Edible Portion. 



Water. 



Nutrients. 



Total. 



Pro- 
tein. 



Fats. 



Carbo- 
hydrates, 



Mineral 
matters. 



Calories 
of poten- 
tial en- 
ergy in 

one 

pound 

of each 

material. 



Animal foods, edible portion: 

Salmon 

Oysters, fat 

Oysters, lean .... 

Oysters, average . . . 

Hens' eggs ..... 

Cows' milk 

Cows' milk 

Cheese, whole milk . . 

Cheese, skimmed milk . 

Butter 

Oleomargarine .... 

Lard 

Vegetable foods : 

Wheat bread .... 

Wheat flour 

Graham flour .... 

Eye flour 

Buckwheat flour . . . 

Beans 

Oatmeal 

Corn (maize) meal . . 

Bice 

Sugar 

Potatoes l 

Potatoes 

Sweet potatoes .... 

Turnips 

Carrots 

Cabbage 

Melons 

Apples 

Pears 

Bananas 



pr. ct. 



10.0 



Beverages: 

Lager beer . . . 
Porter and ale . . 
Rhine wine, white 
Rhine wine, red . 
French wine, claret 
Sherry wine . . . 



pr. ct. 
63.6 
81.7 
90.9 
87.1 
73.1 
87.4 
90.7 
31.2 
41.3 
10.0 
10.0 
1.0 

32.7 
11.6 
13.0 
13.1 
13.5 
13.7 

7.7 
14.5 
12.4 

2.2 
68.0 
75.5 
75.8 
91.2 
87.9 
90.0 
95.2 
84.8 
83.0 
73.1 



90.3 
88.1 
86.3 
86.9 
88.3 
79.5 



21.6 


13.4 


8.0 1.7 


4.2 


0.6 


6.0 


1.2 


13.7 


11.7 


3.4 


3.7 


3.1 


0.7 


27.1 


35.5 


38.4 6.8 



1.0 
0. 



8.9 
11.1 
11.7 
6.7 
6.5 
23.2 
15.1 
9.1 
7.4 
0.3 
1.8 
2.0 
1.5 
1.0 
1.0 
1.9 
1.1 
0.4 
0.4 
1.9 



8o.O 
84.5 
99.0 

1.9 
1.1 
1.7 
6.7 
1.3 
2.1 
7.1 
3.8 
0.4 

0.2 
0.2 
0.4 
0.2 
0.2 
0.2 
0.6 



0.6 
Alco- 
hol. 
0.4 2.0 



0.6 



5.1 

9.3 

8.1 

8.0 

17.0 



1.8 
3.7 
0.5 

4.8 
4.8 
2.3 
8.9 
0.5 
0.4 



pr. ct. pr.ct. pr. ct. pr. ct. 
36.4 
18.3 

9.1 
12.9 
26.9 
12.6 

9.3 
68.8 
58.7 
90.0 
90.0 
99.0 

67.3 
88.4 
87.0 
86.9 
86.5 
86.3 
92.3 
85.5 
87.6 
97.8 
22.0 
24.5 
24.2 

8.8 
12.1 
10.0 

4.8 
15.2 
17.0 
26.9 



55.5 
75.6 
71.8 
78.7 
77.6 
57.4 
68.1 
71.0 
79.4 
96.7 
19.1 
21.3 
21.1 
6.9 
10.1 
6.2 
2.5 
14.3 
16.3 
23.3 

5.8 
6.8 
2.3 
3.0 
2.3 
3.3 



pr. ct. 
1.4 
1.9 
2.5 
2.0 
1.0 
0.7 
0.7 
3.9 
4.6 
3.5 
4.5 



1.0 
0.6 
1.8 
0.7 
1.1 
3.6 
2.0 
1.6 
0.4 
0.8 
0.9 
1.0 
1.2 
0.7 
0.8 
1.2 
0.6 
0.5 
0.3 
1.1 

0.2 
0.4 
0.2 
0.3 
0.2 
0.3 



965 

345 

135 

230 

760 

310 

175 

2045 

1165 

3615 

3585 

4180 

1280 

1660 

1625 

1620 

1620 

1585 

1845 

1650 

1630 

1800 

395 

440 

435 

155 

215 

170 

90 

275 

310 

495 



Water forms such an important part of the body that its free 
ingestion is advisable, if it is pure, in nearly all cases of disease. 

Having considered the general theory of feeding, we may now pro- 
ceed to the actual preparation of food for the sick. There are several 
important general facts to he borne in mind in this connection: 

1. The food when prepared must be capable of ready assimilation. 

2. It must be, as a rule, fairly concentrated in the sense of contain- 

\ As purchased, Including refuse, skin, etc. 



PEPTONIZED MILK. 513 

ing great nutritive power in little bulk, since it is a mistake to weary 
a feeble patient w r ith much swallowing. 

3. It must be easily swallowed. 

4. It must be as attractive to the sight, smell, and taste as possible. 
When milk is given for any length of time its taste should be 

varied, if possible, by the addition of enough coffee, tea, cocoa, or 
sweetening to prevent the patient from taking a dislike to it. Its 
nutritive properties may often be advantageously increased by the 
addition of some of the well-known infant foods ; and if it curdles too 
quickly in the stomach, this may be delayed by the use of barley- 
water in equal parts, or lime-water, or by the addition of thin oat- 
meal gruel or strained rice to the milk. Often the addition of salt 
improves the taste and aids its digestion, and its dilution by adding 
aerated or carbonated w T ater from a siphon is also refreshing and aids 
digestion in some instances. In other instances the best results are 
produced by peptonizing the milk (see below). When broths are 
used, they may well be flavored with other things than the meat from 
which they are made. This is easily accomplished by placing in a 
small bag such vegetables as carrot, turnip, celery, parsnip, parsley, 
thyme, etc., and then cooking this bag and its contents with the broth, 
whereby the nutritive properties of the meat and vegetables and the 
flavoring of the latter are given to the soup. 

The following recipes will be found useful in many cases : 

PEPTONIZED MILK. 

Take a perfectly clean, clear glass quart bottle and place in it one 
of Parke, Davis & Co.'s peptonizing tablets, or the contents of one 
of Fairchild's peptonizing tubes, and a teacupful of cold water, and 
after shaking pour into the bottle a pint of perfectly fresh, cool milk 
and stir the mixture thoroughly. Next place the bottle containing the 
milk in a can of water at such a temperature that the whole hand 
may be submerged in it without pain. If complete digestion of 
the milk is desired, this application of heat may be continued as long 
as twenty minutes, but in most cases five minutes are sufficient. If 
carried on longer than five minutes, the milk will become bitter 
and disagreeable to the taste through the development of peptone in 
excess. 

Immediately after taking the bottle from the hot water it should 
be placed on ice, in order to check further peptonizing and to keep 
the milk from spoiling ; or if the ice is not available the water-bath 
should be quickly brought to a boil in order to prevent further action 
of the ferment, and the bottle corked and then be put in a cool place. 
This recipe may be used where it is thought necessary to digest the 
milk before it is swallowed. Where we desire simply to aid digestion 
it is best to follow the directions already given, except that the bottle 
is not heated, but at once placed upon ice and allowed to remain 
there, being slightly warmed when it is desired to give it to a child, 
or it may be given as a cool and refreshing drink to an adult, the 
heat of the body rapidly causing the ferment to do its work as soon 

33 



514 FEEDING THE SICK. 

as the food enters the stomach. When irritability of the stomach 
exists in adults, this peptonized milk may be made more agreeable to 
the taste by following the directions given in the first recipe, except 
that it must remain in the hot water for no less than two hours, when 
it is poured out into a tin cup or pan and rapidly brought to the 
boiling-point. After this it is strained through a piece of coarse 
muslin and placed upon ice. Before giving it to a patient this mix- 
ture may be flavored with lemon- or orange-juice or any form of acid 
that is desired, without the milk becoming curdled. Peptonized milk 
punch is made from milk prepared in the way already described in 
the first recipe by adding St. Croix or Jamaica rum or brandy, 
and is a pleasant nutrient, particularly if the surface of the liquid 
is sprinkled with a little grated nutmeg. 

A very refreshing and agreeable drink may be made by diluting 
peptonized milk one-half with highly-charged carbonic-acid water, 
and swallowing it while effervescing. 



PEPTONIZED BEEP. 

The following method of preparing Peptonized Beef is recom- 
mended by the Fairchilds, and is very useful, as is also peptonized 
oyster stew, as first introduced by the author's friend, the late Dr. N. 
A. Randolph. 

Take \ pound of finely-minced raw lean beef; cold water, \ pint. 
Mix in a saucepan. Cook over a gentle fire, stirring constantly until 
it has boiled a few minutes. Then pour off the liquor for future use, 
beat or rub the meat to a paste, and put it into a clean fruit-jar with 
\ a pint of cold water and the liquor poured from the meat, and add 

Extracti pancreatis 20 grains (1.3). 

Sodii bicarb 15 " (1.0). 

Shake well together, and set aside in a warm place, at about 110° to 
115° F., for three hours, stirring or shaking occasionally ; then boil 
quickly. The liquid may then be strained or clarified with white of 
egg in the usual manner, and seasoned to taste with salt and pepper. 

In the great majority of cases it is not necessary to strain the 
peptonized liquor, for the portion of meat remaining undissolved will 
have been so softened and acted upon by the pancreatic extract that 
it will be in very fine particles and diffused in an almost impalpable 
condition, and is therefore in a form ready for assimilation in the 
body. 

Peptonized Oysters. — Peptonized Oysters are prepared by mincing 
six to twelve large oysters, and adding to them, when mixed with a 
moderate amount of their own liquid, 5 grains (0.35) of pancreatin 
or peptonizing powder and 20 grains (1.3) of sodium bicarbonate. 
The cup containing this mixture is now placed in warm water at 
100° F., and allowed to remain there from ten to twenty minutes, 
according to the degree of digestion desired. After this the liquid 



PEPTONIZED ENEMA. 515 

mass is quickly brought to a boil to cook the oysters and stop diges- 
tion, and served with pepper and salt as required. Any condiment 
or flavoring substance may be used. 



PEPTONIZED ENEMA. 

A very useful nutrient enema may be prepared by following the 
directions given above for peptonizing milk, except that an egg, yelk 
and white, should be beaten up in the milk before the ferment is 
added. The effect of this enema may be increased by the addition 
of a teaspoonful to an ounce of whiskey or wine. This should be 
warm when injected into the rectum. 

As the rectum is apt to become irritable if injections are given 
frequently, and particularly if the same mixture is repeated a number 
of times, it is often well to substitute for the formula just given the 
following recipes : 

Von Leube recommends 5 ounces of scraped meat, chopped very 
fine, and to this are added 1^- ounces of finely chopped pancreas ; 
the whole is suspended in 3 ounces of lukewarm water, and stirred 
to the consistence of a thick pulp. This makes one injection. 
Pancreatin or peptonizing tablets can be as well used as the pancreas 
itself. 

Mayet uses 150 to 200 grammes of pancreas bruised in a mortar 
with water at a temperature of 100° F., and then strained through 
a cloth ; 400 to 500 grammes of lean meat are chopped fine, and the 
strained pancreatic fluid mixed with the mince, together with the 
yolk of 1 egg. This is allowed to stand for two hours, and should be 
administered at the body temperature ; the quantity is sufficient for 
twenty-four hours' nourishment, and should be administered in two 
parts. 

Rennie's formula consists of \ pound of lean meat pulled into 
shreds and added to a pint of beef-tea ; to this are added 1 drachm 
of fresh pepsin, and \ a drachm of dilute hydrochloric acid ; the mixt- 
ure is kept at a temperature of 99° F. for four hours, during which it 
is stirred constantly. If too great heat be employed, the digestive 
process will stop. 

An enema which Bidwell employs is made as follows : Milk, 2 
ounces ; strong beef-tea, 2 ounces ; yolk of egg, 1 ; pancreatic solu- 
tian, 1 drachm. This is to be prepared one hour before use, and to 
be kept at a temperature of 100° F. \ to 1 ounce of brandy is added, 
when necessary, immediately before use. 

Greig Smith uses 1 egg beaten up in 6 ounces of milk with 2 
or 3 teaspoonfuls of meat-jelly, or peptones may be added. This is 
administered warm with or without \ an ounce of brandy every five 
or six hours. 



516 FEEDING THE SICK 



DIGESTED GRUEL. 

Digested Gruel may be made by taking thoroughly boiled hot 
gruel made from oatmeal, barley, wheat, or from arrow-root, to the 
amount of J pint (250 cc), and adding thereto, while it is hot, J pint 
(250 cc.) of fresh, cold milk ; to this may now be added the contents 
of one peptonizing tablet or tube, and the mixture allowed to stand in 
moderately hot water or in a warm place for twenty minutes before it is 
placed upon ice. 

KOUMYSS. 

This is a preparation of milk which is very useful for children and 
adults during convalescence from acute or subacute exhausting dis- 
eases. Even young children of three or four years will take a fancy 
to it if it is not made too sour by continuing the fermentation process 
too long. The liquid is prepared as follows : Add to 1 pint (500 cc.) 
of cool, perfectly fresh milk 2 teaspoonfuls (8.0) of sugar, and place 
it, after shaking thoroughly, in a clear beer or claret bottle. Then add 
J of a cake of Fleischman's compressed Vienna yeast, and tightly cork 
the bottle, standing it in a warm place or in a water-bath at 99° to 
100° F. for eight to ten hours. Then place in a cool place or on ice 
and use as needed. It must be remembered that the development of 
carbonic gas is very great in this liquid, and that if an ordinary cork 
is inserted it must be tied in before the heat is applied. Further 
than this, the cork must be pulled very gently or the liquid will 
spurt all over the room. The best thing to use when about to open 
a bottle of koumyss is a " champagne tap," by means of which the 
liquid may be drawn off as needed. 



DIET LIST. 

The following bills of fare are used in the Children's Hospital in 
Philadelphia with good results, are easily prepared, and the directions 
readily carried out by the inexperienced. 

Diet in Gastro-intestinal Catarrh for a Child, of Seven Years. 

Breakfast, 7.30 a. m. : Milk, with lime-water; 4 teaspoonfuls of 
lime-water to each tumblerful of milk. The lightly-boiled yelks of 
two eggs, thin slices of well-toasted bread or stale bread. 

Dinner, 12 M. : A mutton-chop without fat, broiled, or a slice of 
roast beef or mutton, occasionally a bowl of meat broth. Stale bread 
or toast. 

Supper, T P. m. : Milk and lime-water. Stale bread or toast, or 
milk-toast. 

For drink : Filtered or boiled water. 

Starch foods to be avoided as much as possible. 



BEEF TEA. 517 

Diet for a Child Two Years Old. 

Breakfast, 7.30 a. m. : Milk. The lightly-boiled yelk of an egg. 
Thin bread and butter (the bread to be one day old). 

Lunch, 11 a. m. : Milk. A thin slice of bread and butter. 

Dinner, 1.30 p. m. : Beef-tea or small piece of minced roast beef 
or mutton devoid of gristle. One well-mashed potato, moistened with 
gravy. Rice and milk. 

Supper, 6 p. m. : Milk. Bread and butter. 

For drink : Boiled or filtered water. 

Diet for a Child One Year Old (5 meals a day). 

First meal, 7 A. M. : 2 teaspoonfuls of grated flour-ball (prepared 
as directed below) in J a pint of milk. 

Second meal, 10.30 A. M. : J a pint of milk with 4 tablespoonfuls 
of lime-water. 

Third meal, 2 p. M. : The yelk of 1 egg beaten up in 1 teacupful 
of milk. 

Fourth meal, 5.30 p. M. : Same as the first. 

Fifth meal, 11 p. m. : Same as the second. 

Flour-ball is to be made by taking one pound of good flour — 
unbolted, if possible — tie it up very tightly in a pudding-bag ; put it 
in a pot of boiling water early in the morning, and let it boil until 
bed-time, then take it out and let it dry. In the morning peel off 
the surface and throw away the thin rind of dough, and with a grater 
grate down the hard, dry mass into a powder. To use this, take from 
1 to 2 teaspoonfuls of the powder, rub it down until smooth with a 
tablespoonful of cold milk, and add 1 tumblerful of hot milk, stirring 
it well all the time. 

Diet for a Child from Six to Tivelve Months Old (5 meals a day). 

First meal, 7 A. M. : Mellin's food 1 tablespoonful or flour-ball 
grated 1 or 2 teaspoonfuls (prepared as directed above), hot water 4 
tablespoonfuls ; warm milk enough to make J a pint. Dissolve the 
Mellin's food or rub down the grated flour-ball in the hot water by 
stirring, then add the milk ; mix thoroughly. 

Second meal, 10.30 a. m., and third meal, 2 p. M. : A breakfast- 
cupful of milk with 4 tablespoonfuls of lime-water. 

Fourth meal, 5.30 p. m. : Same as first. 

Fifth meal, 10.30 p. m. : Same as second. 



BEEP TEA. 

Take 1 pound of lean beef and mince it. Put it, with its juice, 
into an earthen vessel containing a pint of tepid water, and let the 
whole stand for one hour ; strain well, squeezing all the juice from 
the meat. Place on the fire, and slowly raise just to the boiling-point, 
spring it briskly all the time. Season with salt and pepper to taste. 
In administering this always be careful to stir up the sediment. 



518 FEEDING THE SICK. 

Or, take 2 pounds of beef, without fat or bone, half a breakfast- 
cupful of cold water; place it in a jar in a saucepan of water. Sim- 
mer four hours. 



RESTORATIVE BEEP ESSENCE {Ringer). 

Take 1 pound of fresh beef, free from fat, chop it up fine, and 
pour over it 8 ounces of soft water, add 5 or 6 drops of hydrochloric 
acid and 50 or 60 grains of common salt ; stir it well, and leave it 
for three hours in a cool place. Then pass the fluid through a hair 
sieve, pressing the meat slightly, and adding gradually toward the 
end of the straining about 2 ounces more of water. The liquid thus 
obtained is of a red color, possessing the taste of soup. It should 
be taken cold, a teacupful at a time. If preferred warm, it must not 
be put on the fire, but heated in a covered vessel placed in hot water. 

Should it be undesirable for the patient to take the acid, this soup 
may be made by merely soaking the minced beef in distilled water ; 
or, take 1 pound of lean beef, free from fat and skin, chop it up 
very fine, add a little salt, and put it into an earthen jar with a lid, 
such as is used for roasting venison, fasten up the edges with a thick 
paste, and place the jar in the oven for three or four hours. Strain 
through a coarse sieve, and give the patient two or three teaspoonfuls . 
at a time ; or, cut up in small pieces 1 pound of lean beef from the 
sirloin or rump, and place it in a covered saucepan, with J a pint of 
cold water, by the side of the fire for four or five hours, then allow it 
to simmer gently for two hours, skim it well, and serve. 



BARLEY-WATER. 

To prepare barley-water, put two good-sized teaspoonfuls of washed 
pearl barley with 1 pint of cold water in a saucepan, and boil slowly 
down to two-thirds. Strain. 



Barley-water for Adults. 

Take of finest barley \ pound; to this add 1 quart of water and 
boil to 1 pint ; strain and add 1 quart of boiled milk. To this add 
6 ounces each of brandy and lime-water ; sweeten to taste ; flavor 
with nutmeg and rind of lemon rubbed with sugar. This forms a 
most nourishing and palatable drink when kept cold on ice. 



RICE-WATER. 

Rice-water is made by boiling 2 ounces of clean rice in 2 quarts 
of water for an hour and a half. 



BRAN BREAD FOR DIABETICS. 519 



WINE-WHEY. 



Boil 1 pint of fresh milk ; while boiling pour in 1 small tumbler- 
ful of sherry wine (8 tablespoonfuls) ; bring it to the boil a second 
time, being careful not to stir it ; as soon as it boils set it aside until 
the curd settles, and pour off the clear whey. 



ALMOND BREAD FOR DIABETICS. 

Take of blanched sweet almonds J pound ; beat them as fine as 
possible in a stone mortar ; remove the sugar contained in this meal 
by putting it into a linen bag and steeping it for a quarter of an hour 
in boiling water acidulated with vinegar ; mix this paste thoroughly 
with 3 ounces of butter and 2 eggs. Next add the yelks of 3 eggs 
and a little salt, and stir well for some time. Whip up the whites of 
3 eggs and stir in. Put the dough thus obtained into greased moulds, 
and dry by a slow fire. 



BRAN BREAD FOR DIABETICS. 

Take a sufficient quantity (say 1 quart) of wheat bran ; boil it in 
two successive waters for a quarter of an hour, each time straining it 
through a sieve ; then wash it well with cold water (on the sieve) 
until the water runs off perfectly clear ; squeeze the bran in a cloth 
as dry as possible, then spread it thinly on a dish and place it in a 
slow oven ; if put in at night, let it remain until morning, when, if 
perfectly dry and crisp, it will be fit for grinding. The bran thus 
prepared must be ground in a fine mill and sifted through a wire 
sieve of such fineness as to require the use of a brush to pass it 
through ; that which remains in the sieve must be ground again until 
it becomes quite soft and fine. Take of this bran powder 3 ounces 
(some patients use 4 ounces), the other ingredients as follows : 3 
new-laid eggs, 1J ounces (or 2 ounces if desired) of butter, and about 
\ pint of milk ; mix the eggs with a little of the milk, and warm the 
butter with the other portion ; then stir the whole well together, add- 
ing a little nutmeg or ginger or any other agreeable spice. Bake 
in small tins (patty-pans), which must be well buttered, in a rather 
quick oven for about half an hour. The cakes, when baked, should 
be a little thicker than a ship's biscuit : they may be eaten with meat 
or cheese at breakfast, dinner, and supper ; at tea they require rather 
a free allowance of butter, or they may be eaten with curd or any of 
the soft cheeses. 

"It is important that the above directions as to washing and dry- 
ing the bran should be exactly followed, in order that it may be 
freed from starch and rendered more friable. The bran in its com- 
mon state is soft, and not easily reduced to fine powder. In some 
seasons of the year, or if the cake has not been well prepared, it 
changes more rapidly than is convenient, owing to moisture. This 



520 FEEDING THE SICK. 

may be prevented by placing the cake before the fire for five or ten 
minutes every day." 

ARTIFICIAL MILK FOR DIABETICS. 

Williamson has given the folloAving recipe : " To about a pint of 
water placed in a large drinking-pot or tall vessel, about two or three 
tablespoonfuls of fresh cream are added and well mixed. The mixture 
is allowed to stand for twelve or twenty-four hours, when most of the 
fatty matter of the cream floats to the top ; it can be skimmed off with 
a teaspoon easily, and on examination it will be found practically free 
from sugar. The milk-sugar remains dissolved in the water. This 
fatty matter thus separated is placed in a glass and mixed with water. 
Then the white of an egg is added and the mixture well stirred. The 
water and white of the egg are added in sufficient quantities to make a 
mixture which has the exact color and consistence of ordinary milk. 
If a little salt and a trace of saccharine be added, a palatable drink is 
obtained which has almost the same taste as milk, and which contains 
a large amount of fatty material and is practically free from milk- 
sugar. With very little practice the right proportions can be easily 
guessed, and, of course, much larger quantities than those mentioned 
can be prepared." 

MULLED WINE. 

Boil some spices, cloves, nutmeg, cinnamon, or mace in a little 
water, and add as much of this decoction as is necessary to flavor a 
wineglassful of sherry or any other wine. Add sugar to taste, and 
bring the mixture to the boiling-point. If claret is used, it will 
require more sugar than if a less sour wine is employed. The vessel 
for heating the wine should be scrupulously clean. 

WATERED TOAST. 

Brown several pieces of bread, and carefully butter the toast so that 
the butter is equally distributed. Place enough salt over the toast to 
flavor it and add pepper to taste. Finally pour as much boiling water 
on the edges of the crust as is necessary to thoroughly soak them, and 
3erve to the patient. This is a more agreeable dish than would be 
imagined, and is useful where milk toast is distasteful. 

JUNKET. 

Add from \ to 1 teaspoonful of Parke, Davis & Co.'s pepsin cor- 
dial or Fail-child's essence of pepsin to a pint of milk, which should 
be at body-heat. Place the milk in a cool place, and after the curd 
has formed serve cold and flavor with powdered nutmeg or vanilla. 
[f there be too great feebleness of digestion to digest the curd, the 
liquid whey may be given, as it contains the salts and soluble albu- 
minoids of milk. 



PART IV. 
DISEASES. 



ABORTION. 



The treatment of abortion divides itself into three parts : the first 
for its prevention, the second for its arrest when threatened, the third 
for its proper care when inevitable. 

In the preventive means we find, as in nearly every branch of 
medicine, that the use of hygienic measures is more important than 
the employment of drugs. If the previous abortions are known to be 
due to syphilis, endometritis, or uterine displacements, these conditions 
must be relieved by the proper remedies. If there exists no apparent 
cause for the interruption of normal gestation, the patient should use 
a simple diet, lead a quiet life, avoid all sexual intercourse, sleep on a 
hard bed, and resort only to gentle exercise. Fresh air is, however, 
a necessity, and should be plentifully supplied. The food should be 
light, but nutritious and palatable, and a sufficient variety supplied to 
avoid any repugnance to a given dish. In many cases abortion rests 
upon deficient nutrition of the foetus, either by reason of faulty assim- 
ilation on the part of the mother or because of poor food, so that if 
anaemia, debility, or other impoverished states of the maternal system 
be present, these should be treated at once. The clothing should be 
loose, the night's sleep undisturbed and of full length, and the mind 
be set at rest as far as possible in respect to household and other wor- 
ries, and particularly diverted from the thought of possible uterine 
disturbance. 

The use of drugs is to be limited strictly to the fulfilment of a dis- 
tinct indication, and the employment of cathartics is to be avoided, 
the bowels being kept in order by fresh fruits in moderate quantity 
or by mild laxatives, such as cascara sagrada in small doses and com- 
pound liquorice powder. If these fail, rhubarb may be resorted to, 
and castor oil in capsule may be used. Podophyllin, senna in full 
doses, saline purges in active amounts, and aloes are not to be used 
if they can be avoided. If the woman be exceedingly stout and pleth- 
oric, saline purges are indicated to act as depletants. It is hardly 
necessary to add that elaterium and scammony or jalap are not safe, 
and can only be used if dropsy and ascites are present, and where we 
must choose the least of two evils. Strychnine, which stimulates the 
spinal cord, should never be employed, and cantharides, oil of erigeron, 
and manganese ought not to be used unless they are for some reason 

521 



522 DISEASES. 

very necessary. Although quinine is not of itself an abortifacient, it 
is unsafe in very large doses if an abortive tendency is present, and can 
only be used as a prophylactic in cases in which the abortion is brought 
on by malarial poisoning. 

The only drug which seems to be of any service as a prophylactic 
to be taken all through pregnancy is the fluid extract of viburnum 
prunifolium, the dose of which is \ to 1 drachm (2.0-4.0). This drug 
is said to be a uterine sedative and to have no injurious effects upon 
the mother or child. 

The arrest of threatened abortion is one of the most difficult duties 
which come to the physician, and there is no doubt that large doses 
of morphine or opium are the best means we have of quieting the ute- 
rus. While viburnum prunifolium may be resorted to, we do not 
know enough of it to rest assured of its value, but it should be tried 
if opium is not at hand or fails. The patient should be at once quietly 
placed in bed in the most comfortable position, be so covered as to 
prevent overheating and taking cold, and receive by the hypodermic 
needle \ grain (0.016) of morphine, or, better still, a rectal injection 
of warm starch-water containing 45 minims (3.0) of laudanum. The 
bulk of the injection should be small, in order not to disturb the 
bowels, and must be at the body temperature. If this is not done, 
a suppository of the aqueous extract of opium, containing \ to \ grain 
(0.016-0.03), should be used. Ice-cold drinks should be given, and no 
tea or coffee allowed. This treatment quiets the uterus, allays ner- 
vousness and restlessness, and at least puts off the abortion for a few 
hoars. Venesection has been practised in very plethoric women with 
advantage. 

When an abortion is inevitable, it is to be treated by measures directed 
to the avoidance of hemorrhages, the thorough delivery of the ovum 
and its appendages, and the prevention of inflammation and septi- 
caemia. The latter accident is to be prevented by the most rigid 
asepsis of the patient and physician. For the prevention of hemor- 
rhage a number of balls of aseptic absorbent cotton tightly wound 
with thread to the size of a small egg should be packed into the 
vagina back of and around the cervix until the bleeding is con- 
trolled, and, while a small amount of iodoform may be dusted 
over them before they are inserted, no astringents are to be applied, 
unless it be tannic acid to coagulate the blood in the cotton, as 
astringents cannot reach the bleeding spot. Sponges ought never to 
be used, as they often fail to control the bleeding and rapidly become 
septic. By means of this packing the blood in the uterus cannot 
escape, and, as the uterine walls contract, they urge the liquid between 
the membranes, thereby causing complete separation. Ergot should 
be used after the tampons are applied in the dose of a fluidrachm of 
the extract or a tablespoonful or two of the wine. Generally after 
twenty-four hours the removal of the tampons will show the ovum to 
be in the vagina, but if part of it remains in the uterus, the following 
measures should be resorted to: The administration of ergot should 
be stopped unless the hemorrhages are severe, and the uterine cavity 



ABSCESS. 523 

is to be cleared by the use of the fingers of the attendant, who grasps 
the membranes and draws them away. In skilful hands the curette 
may be employed. If the cervical canal is too small, it must be 
dilated by dilators. After the membranes are removed the tincture of 
iodine may be applied to the inner surface of the uterus as a haemostatic, 
antiseptic, and alterative ; or, better still, the uterus should be douched 
with a 2 per cent, solution of creolin in warm water, about a quart 
being used. 

The after-treatment consists in the use of small doses of ergot and 
quinine, of vaginal antiseptic irrigation, or even of uterine irrigation 
if it is needed, and the maintenance of perfect rest for one or two 
weeks, or longer if possible. Ergot ought not to be given if there is 
reason to believe that portions of the membranes or blood-clots are in 
the uterus, as by contraction of the os uteri it may imprison materials 
which then become septic. (See Puerperal Diseases.) Should fever 
arise, the uterus should be carefully curetted and the intra-uterine 
douches of creolin continued until the fever disappears. 



ABSCESS. 

The medical treatment of abscess resolves itself into the use of 
drugs to prevent the further formation of pus, to cause its fatty degen- 
eration and absorption, to quiet the systemic disturbance if the inflam- 
mation be severe, and to support the body if the suppuration be pro- 
longed or in large amount or if debility exists. The treatment may 
also be divided into that suited to acute and that to chronic abscess. 

As acute abscess in its early stages is simply a localized inflamma- 
tion with hyperemia and an outpouring of leucocytes, it may often 
be modified by the use of aconite or veratrum viride in full dose to 
quiet the circulatory excitement and relieve the congestion. This is 
particularly true where the pain is pulsating. At the same time, if 
the swelling is superficial, a poultice, made by moistening bread- 
crumbs with lead-water, should be placed over it, or lead-water may 
be placed on lint and applied in this way. Belladonna ointment 
smeared over the same area may be of service, and the tincture may 
be used internally if aconite cannot be had. If a gland be involved, 
the needle of a hypodermic syringe may be inserted obliquely into 
its centre and 5 to 10 minims (0.3-0.65) of a 2 per cent, solution of 
carbolic acid injected into the swelling. This method has been found 
of singular efficacy in bubo where pus seemed just about to form. It 
is very often curative, but should not be used in a stronger or weaker 
solution than that named. Another useful abortive method for the 
treatment of the early stages of abscess is the application, exter- 
nally, of a strong solution of nitrate of silver, 20 to 40 grains to 1 
ounce (1.3-2.6 : 32.0) of water, by means of a camel's-hair brush, all 
over the skin covering the area involved, or by the use of the tinct- 
ure of iodine in a similar manner. 

Internally, calx sulphurata, in the dose of ^ grain (0.006) given 
every hour or two, may be used as an abortive, or at least to promote 



524 DISEASES. 

arrest and cause absorption. If it becomes evident that pus is going 
to form, then resort must be had to poultices, which by their heat and 
moisture will aid in the formation of pus by favoring the escape of 
leucocytes and by softening the tissues. The best form of poultice for 
this purpose is to use lint which has been saturated with a 1 : 4000 
solution of mercuric chloride, the moisture being retained by a piece of 
rubber dam placed over the lint. If pus forms and fluctuation ensues, 
the abscess should be freely opened, drained, washed out by a solution 
of carbolic acid in the strength of 1 : 20, or of bichloride solution 
1 : 5000, and dressed with antiseptic gauze. If it is tubercular, the 
abscess may be opened in the ordinary manner, all diseased tissues 
removed by scraping, and the cavity packed with iodoform gauze, or it 
should be drained by aspiration, and an ethereal solution of iodoform 
injected and allowed to remain in the abscess-cavity if it is a small one. 
The opening is now closed by a pledget of cotton Avet with tincture of 
benzoin, and an antiseptic dressing applied over it. Not more than 20 
grains (1.3) of iodoform should be so used in the treatment of tuber- 
cular abscess, as larger amounts have caused poisoning. 

A very good treatment for slow abscess is to wash out the cavity 
with a 10- volume solution of peroxide of hydrogen, provided there is 
a free exit for the gas which is given off. 

If the abscess is chronic (cold abscess) and associated with great 
weakness, resort must be had to the internal use of iron in the form 
of the tincture of the chloride, cod-liver oil with hypophosphites, qui- 
nine as a tonic to prevent hectic fever, and the use of nutritious, 
easily-digested food. Alcohol may be used and should be given with 
milk or in egg-nogg. 

The following tonic pill or solution is of service : 

R. — Strychninse sulph gr. j (0.05). 

Ferri redact gr. xv (1.0). 

Quininse sulph gr. xx (1.3). — M. 

Ft. in pil. No. xx. 
S. — One t. d. after meals. 

Or, 

R . — Tr. cinchonse comp. "| 

Tr. gentian, comp. V aa fgiij (90.0). — M. 

Tr. cardamom, comp. J 
S. — Dessertspoonful (8.0) t. d. after meals. 

Having described the means of treatment, it is to be explained 
how these measures act. The aconite quiets the circulation and 
thereby relieves the inflammation, the lead-water acts locally as an 
astringent and sedative, while the belladonna by its action on the 
blood-vessels contracts the dilated capillaries and allays pain. When 
carbolic acid is injected into an enlarged gland, it acts as an anaes- 
thetic, as an antiseptic, and as an astringent and stimulant. The 
nitrate-of-silver applications act by constringing the blood-vessels, as 
local sedatives, and as counter-irritants. The iodine applications do 
likewise and also exorcise an alterative influence. 

The physiological action of calx sulphurata is unknown. The 
objeel in using the antiseptic irrigations is self-evident, and the 
employment of iodoform in tubercular abscess rests upon the studies 



ACNE. 525 

of Brims of Tubingen and many others, who have found by experi- 
ment that the use of iodoform is fatal to the bacillus tuberculosis. 

As large numbers of corpuscles are destroyed in the formation of 
pus, and other sources of vitality are sapped by its formation, the use 
of hypophosphites and iron to replace the loss is necessary, and of 
cod-liver oil and tonics to increase the blood-corpuscles and the abil- 
ity to assimilate food. 

ACNE. 

This affection occurs in so many forms and arises from such differ- 
ent causes that a thorough consideration of its treatment cannot be 
here given: suffice it to state that arsenic is a remedy which will often 
aid in the cure and prevent a relapse if used in small doses for a long 
period; that is, 1 to 3 minims (0.06-0.18) of Fowler's solution three 
times a day for a month or two. This is particularly useful if debility 
and anaemia underlie the disease. If the anaemia be marked, the 
proper treatment is that directed to the cure of this condition (see 
Anaemia) ; if obstinate constipation is present, relief must be obtained 
by saline purges and the bowels kept in order by cascara sagrada or 
some similar drug. If scrofulosis exists, cod-liver oil is of great ser- 
vice, or if much pustulation is present, calx sulphurata, in the dose 
of y 1 ^- to -§- of a grain (0.006-0.008), may be used in pill form three 
times a day. In menstrual acne sulphur may be used internally to 
open the bowels and applied as a wash to the face in the following 
form : 

R .— Sulphuris &j (4.0). 

Glycerini . fjj (32.0). 

Aquae rosae q s. ad f^viij (250.0). — M. 

S. — Apply twice or thrice a day. 

Or the following may be used in cases of severe inflamed acne : 

R. — Sulphuris iodidi gr. xxx (2.0). 

Cerati simplicis %] (32.0). — M. 

S. — Apply to the parts night and morning. 

If the skin is very atonic, muddy, and torpid, it should be bathed 
night and morning with hot water and castile soap, or even Avith the 
tincture of green soap, and well rubbed with a wet towel. After this 
the following salve may be thoroughly applied : 

R . — Sulphur, precip ^ss. 

Lanolin, ") -- .■? -»*■ 

Adepis, } aagss.— M. 

S. — Apply as directed. 

If the green soap causes irritation, some bland application should 
follow it, such as simple cerate or the emulsion of the oil of sweet 
almonds. If the pustules be large, they may be incised and vent 
given to their contents, the sac being touched with a drop of carbolic 
acid. If induration is great, ichthyol ointment of the strength of 20 
parts of ichthyol to 100 of lard should be well rubbed in, or resorcin, 
10 to 20 grains to the ounce of lard (0.65-1.3 : 32.0), be applied. Mer- 
curial ointment may also be used to relieve induration, but several 



526 DISEASES. 

days must elapse between its use and that of sulphur, as a black sul- 
phuret of mercury may be formed and stain the face. 

The diet should be carefully regulated and fatty foods avoided. 

ADENITIS. 

Adenitis is an inflammation of the lymphatic glands, generally 
arising from scrofulosis, unless there be some speeific trouble, such as 
syphilis, present. Less commonly it occurs in the neck from the irri- 
tation produced by the eruption of milk-teeth, sometimes from blows 
or exposure to cold. 

If the condition consists in a simple enlargement, it should be 
treated by inunctions of iodine ointment and lard, half-and-half, night 
and morning, care being taken that the use of the ointment is stopped 
as soon as any reddening of the skin appears or if fluctuation develops. 
If the ointment cannot be used, the tincture of iodine should be thor- 
oughly painted over the swelling with a brush, but this treatment is less 
efficacious. The following prescription makes a useful application : 

R.— Ichthyol 3iy (16.0). 

Adipis benzoinat §ij (62.0). — M. 

S. — Rub a small piece of the ointment into the swelling t. d. 

Syrup of the iodide of iron, in the dose of 5 to 20 drops (0.35- 
1.3), is to be given if the patient is a child, and tonics must be used 
to improve the systemic condition. As soon as fluctuation or redden- 
ing shows the formation of pus, all this treatment should be stopped, 
and a poultice be applied for twenty-four or forty-eight hours till the 
swelling goes down or is ready for lancing. Lancing is better than 
allowing the abscess to break, as the scar left in after years is a mere 
line instead of a large cicatrix. 

If the enlargement be tuberculous — and a large number of these 
cases are so infected — the following treatment, recommended by Treves 
and Grunfeld, is of value and should be insisted upon. 

The entire removal of the glands should be effected by dissection 
alone ; directors, handles of scalpels, or fingers should be used to 
separate the glands from the surrounding cellular tissue as closely 
from the capsule as a nerve is cleaned in the dissecting-room. When 
sufficient of the anterior surface is exposed, a thick thread is passed 
through the gland and drawn gently, when, by continuing the dissec- 
tion, the operator may gradually get to the back of the gland, remov- 
ing portions of the mass at a time. The cavity should be packed with 
iodoform gauze, and the walls scraped if an abscess has existed. 

ALCOHOLISM. 
(See Alcohol.) 

ALOPECIA. 

This disease, when due to a parasite, is best treated, according to 
Crocker, by first pulling out all the loose hairs around the bald spot 
and then painting the affected surface with linimentum cantharidis 



AMBLYOPIA AND AMAUROSIS. 527 

(liquor epispasticus). Three coats of this liquid should be employed, 
and each coat allowed to dry before the next is applied. In other 
cases an ointment of chrysarobin, J to 1 drachm (2.0-4.0) to the 
ounce (32.0) of lanolin, may be used, but care must be exercised that 
too much staining of the skin and clothes does not result. Another 
equally good application is 2 grains (0.1) of mercury bichloride to 1 
drachm (4.0) of rectified spirit and 7 drachms (28.0) of oil of turpen- 
tine. This mixture may be rubbed in with the finger over and around 
the patch. If the patient's skin will stand it, 5 grains (0.3) of the 
corrosive sublimate may be used in place of 2 grains (0.1). 

AMBLYOPIA AND AMAUROSIS. 

Amblyopia (or dull vision) and amaurosis (or blindness) usually 
refer to defective sight or its total loss, the result of functional dis- 
turbance of the retina, optic nerve, or visual centres, and unaccom- 
panied by changes in the eye-grounds in the beginning of the disease. 
These terms, however, also include cases of partial or complete blind- 
ness in which optic-nerve atrophy subsequently develops, and are often 
used to describe ocular disorders not limited by the definitions here 
employed. 

These cases may be gathered into certain groups : 

I. Congenital amblyopias and amblyopias from non-use of the 
eyes. 

In the former there is often a high degree of error of refraction, 
usually far-sightedness ; the latter is seen when an eye is debarred 
from binocular vision by a squint. In both the treatment consists in 
as perfect a correction of the optical error as possible, and, in case 
one eye alone is involved, the separate exercise of its functions. Con- 
genital amblyopias may include incurable defects in the structure of 
an eye. 

II. Amblyopias the result of (a) general diseases or conditions — 
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds, etc, ; 
(b) local diseases or conditions — hemorrhoids, hemorrhage, pregnancy, 
disordered menstruation, kidney disease, diabetes, migraine, disorders 
of the nervous system, etc. 

The remedies indicated by the special cause are to be employed, 
the medicinal agents most usually needed being mercury, iodide of 
potassium, pilocarpine, particularly in uraemic amaurosis, emmena- 
gogues, and tonics, especially hypodermics of strychnine. As local 
measures repeated fly-blisters to the temples, wet and dry cups, and 
the constant electric current are used. The nape of the neck may be 
cauterized. In hysterical cases metallotherapy may be tried. 

III. Amblyopias the result of the action of certain medicinal and 
toxic agents. 

The abuse of alcohol, and particularly of tobacco, produces a form 
of amblyopia characterized by the development of a scotoma or an 
area in the centre of the field of vision in which the appreciation of 
red and green is lost or greatly diminished. Quinine in excess 
has, in a number of instances, been followed by temporary blindness, 



528 DISEASES. 

which is usually denominated quinine amaurosis. Of less frequent 
occurrence are the cases of amblyopia produced by the toxic action of 
salicylic acid, lead, silver, mercury, osmic acid, nitrobenzol, filix mas, 
and the vapor of sulphide of carbon. In all instances the patient must 
be withdrawn from the influence of the poison ; in tobacco amblyopia, 
in its early stages, this is usually sufficient to effect a cure. The rem- 
edies which have proven of the greatest utility are digitalis, inhala- 
tions of nitrite of amyl, nitroglycerin, and strychnine. Iodide of 
potassium should be exhibited in chronic cases, and always in ambly- 
opias the result of lead-poisoning. The constant current has also 
been employed. 

IV. Amblyopias the result of direct or indirect injury or from 
reflex irritations. 

Traumatic amblyopias may follow a blow upon the eye itself or an 
injury to the skull or spinal cord. To carious teeth, intestinal irrita- 
tions, and the presence of parasites a certain number of amblyopias 
have been attributed, but, while it is not possible to disprove the 
association, such cases must be received with doubt. After the 
removal of the cause strychnine should be exhibited. 

Optic neuritis most frequently depends upon coarse diseases of the 
brain (tumor, abscess) or inflammation of its membranes (meningitis). 
It is also a symptom of numerous disorders — suppression of the 
menses, exposure to cold, rheumatism, anaemia, syphilis, uragmia, 
lead poisoning, etc. The remedies are those naturally suggested by 
the disease or condition which has called it into existence. The prog- 
nosis depends upon the cause. Mercury, iodide and bromide of potas- 
sium, the salicylates, pilocarpine, local bloodletting, and fly blisters 
are the remedies commonly employed. 

Optic-nerve atrophy is either primary or secondary to disease of 
the brain or spinal cord or consecutive to an antecedent neuritis. 
After all irritation has subsided the greatest improvement may be 
expected from hypodermic injections of strychnine, which should be 
pushed to the point of tolerance. Temporary improvement follows 
the inhalation of nitrite of amyl, and, in the hope of improving the 
circulation in the optic nerve, nitroglycerin, digitalis, and similar 
cardiac tonics may be employed. The constant electric current has 
been employed with benefit, especially by voltaic alternations, which 
are more active than simple closures. The following remedial agents 
have also been employed : Suspension, stretching the optic nerve, 
Se'quardian injections, nitrate of silver, lactate of zinc, phosphorus, 
and, quite recently, hypodermics of antipyrine. Mercury may be 
used with benefit in early stages of the degenerative process, but is 
of doubtful value in advanced cases. It may be administered in the 
usual manner or by subconjunctival injection in the dose of -^V m g- 
Suspension and injections of testicular juice have little or nothing 
to commend them. 

AMENORRHCEA. 

This condition depends upon so many causes for its existence that 
it must be treated in many different ways. If ordinary anaemia or 



ANEMIA. 529 

chlorosis shows that there is a deficient supply of blood, measures 
adapted to the relief of such a state are required (see Anaemia). In 
amenorrhoea due to constipation saline purges or other laxatives may be 
used, and the best of these purges is aloes ; and, as constipation and 
anaemia often exist hand in hand, a combination of aloes and iron in a 
pill is commonly resorted to. The iron improves the blood, and the 
aloes stimulates and congests the pelvic viscera by bringing blood to 
the sexual organs. Aloes also seems to increase the assimilation of iron 
in some unknown manner. The following pill is often of service, and 
is especially recommended by Goodell : 

R. — Extract, aloes aqueosi 33(4.0). 

Ferri sulphat. exsiccat £ij (8.0). 

Asafoetidse giv (16.0). 

Ft. in pil. No. c. 
S. — From one to three pills three times a day. 

Cimicifuga has been highly recommended in chronic and appar- 
ently causeless amenorrhoea in the dose of 80 minims (2.0) of the 
fluid extract at the time for a proper flow to occur. Within the last 
few years the binoxide of manganese, in the dose of 1 to 3 grains 
(0.05-0.15), has come prominently forward as a remedy in simple idio- 
pathic amenorrhoea, and is undoubtedly of service, but it should be 
taken for at least two weeks before the date upon which each men- 
struation is expected to occur. Potassium permanganate is also use- 
ful during the same period, but it is inferior to the binoxide of manga- 
nese in the author's experience. 

Apiol, the active principle of parsley, may be given in capsules in 
the dose of 3 to 10 grains (0.15-0.65) in the same manner, and oils 
of rue, savine, and tansy have also been employed in capsule in the 
dose of 5 drops (0.1) three times a day. 

In all forms of amenorrhoea a hot sitz-bath at the time for the 
expected "period" is of service, more particularly if the patient -has 
" caught cold." The bath should be persevered in for several nights, 
and care should be taken to avoid exposure. Often a little mustard 
added to the water will increase the efficacy of this treatment. 

Under the name of " Dewees's Emmenagogue Mixture," first 
devised by Professor Dewees of Philadelphia, the following formula 
has been largely used in functional and organic amenorrhoea : 

R .— Tinct. ferri. chloridi f^iij (12.0). 

Tinct. cantharidis f£j (4.0). 

Tinct. guaiac. ammon f^jss (6.0). 

Tinct. aloes fjss (16.0). 

Syrupi q. s. ad f§vj (180.0).— M. 

S. — Tablespoonful (16.0) three times a day. 



ANEMIA. 

It is, unfortunately, only too true that the entire subject of blood- 
making and blood-breaking is as yet very imperfectly understood, but 
many of our therapeutic facts rest on rational ground now, if not before, 

34 



530 DISEASES. 

and if the pathologists will give us more information upon these subjects, 
new remedial measures will be introduced and the empirical employment 
of old ones placed on a rational basis. Practically speaking, the thera- 
peutist recognizes two very important points, the causes of which the 
pathologist must eventually solve — namely, that one class of anaemias 
are due to defective or deficient haernogenesis, and another to excessive 
haemolysis. The former are generally believed to form the simple class, 
and the latter the essential or pernicious class. It is in the excessive 
haemolysis class that we most frequently fail to produce good results. 
More than this, the causes of excessive haemolysis are so various that we 
can further divide them into removable and permanent, the removable 
being represented by the cases in which copraemia or auto-intoxication 
takes place, while the others are represented by the true pernicious 
anaemia, about which we really know very little, save that most observers 
find evidence of profound haemolysis in the percentage of iron in the 
liver, while in the dark-colored urine they believe a destructive agent 
exists which prior to its excretion has slaughtered many corpuscles. 
Unfortunately, it is at present impossible for us to separate clinically 
the haemogenous anaemia from that of haemolytic excess, unless we find 
evidence of great corpuscular disintegration in a copious elimination 
of haemoglobin in the urine, or a iaundice evidently haematogenous in 
character, or a large number of defective corpuscles, which would per- 
haps indicate defective haemogenesis rather than that they were 
scarred veterans of a battle with a poison in the liver-cells or else- 
where. Post-mortem signs often aid us in the differential diagnosis, 
but this is too late to be of any benefit to the doctor or patient. 

There is one point, however, about which there can scarcely be 
any doubt, and that is that in many cases iron is greatly abused, being 
given when there is no indication for it or more frequently given in 
excessive dose. By excessive dose the author refers to as much as 6 to 
10 grains in a day of reduced iron. The amount of iron in the human 
body is very small, and every study ever made of its absorption and 
elimination after absorption has shown that these processes are very 
slow. Hamburger recovered from the faeces nearly all the iron admin- 
istered, and Jacobi proved that even when the iron was injected into 
the veins 10 per cent, was at once eliminated by the bowels, liver, 
and kidneys, and the remainder deposited in the liver, spleen, and 
other tissues in the same manner as is any metallic substance. The 
researches of Gottlieb have also been in confirmatory lines. When 
we consider that there is in the human blood only about 39 grains of 
iron, all told, we can see that the use of 12 grains a day in the course 
of a little over three days places a double quantity of the metal in 
the economy, which is not needed, and is either cast out or deposited 
at any convenient spot, there to lie undisturbed until it can be 
extruded. 

Much, of course, depends upon the cause of the anaemia, but there 
is only one excuse for the use of the large doses of iron just named — 
viz.. a condition of the digestive apparatus which results in the forma- 
tion of a sulphide of iron in great quantity, so that only an infinitesi- 
mal amount escapes into the system. This perhaps explains the empir- 



ANEMIA. 531 

ical fact that in some cases of chlorosis or intense anaemia iron has to 
be given in large doses to accomplish good results. 

Perhaps the best and most recent studies on this subject are those 
of Ralph Stockman, who has given us a masterly summary of the sub- 
ject of the absorption of iron in chlorosis. In this summary he points 
out that we have three chief theories as to the action of iron in anaemia. 
The first, the absorption theory, is based on the fact that as iron is 
taken into the body with the food, the iron of the haemoglobin must 
be obtained from this source, and therefore that medicinal iron given 
by the mouth must be absorbed. The second theory rests upon the 
belief that iron is not absorbed when given by the mouth in addition 
to that in the food, but simply acts as a stimulant to the mucous 
membrane of the alimentary canal, therefore increasing the digestion 
of food, and so overcoming anaemia by the general improvement coin- 
cident upon proper nutrition. The third theory is that of Bunge — 
namely, that in chlorotic conditions there exists an excess of sulphur 
or sulphuretted hydrogen in the bowel, which changes the iron in the 
food into a sulphide of iron, which Bunge states cannot be absorbed. 
He believes that the inorganic iron which is given as a medicine saves 
the organic iron of the food by combining with the sulphur, and so 
indirectly cures the anaemia by the protection afforded the food-iron. 
It is important to remember that each of these theories has been 
supported by many careful experiments, but it is also well to bear in 
mind that the hypotheses and the experiments supporting them may 
be erroneously based. Thus, we- have no right to imagine that the 
inorganic preparations of iron have a stimulating power over the ali- 
mentary mucous membrane, or, even if they have, that this power is 
exercised in the peculiar line of aiding in the absorption of the 
organic iron of the food. Again, the researches of Hamburger, 
Damaskin, Gottlieb, Miiller, Jacobi, and Socin, which show that after 
the internal use of inorganic iron there is no increase in the iron in 
the urine, are valueless so far as the conclusions drawn by them are 
concerned — namely, that as there is no increase in iron in the urine, 
there is none in the blood, and therefore it is not absorbed. These 
conclusions are not "justified, because thev are based on the erroneous 
view that because iron is not in the urine it is not in the blood, and 
because it is not in the blood it is not absorbed. Every one knows 
that in the case of chronic lead poisoning, when the body is saturated 
with the metal, there is often no lead in the urine, the poison being 
deposited in the tissues ; and if this is true of lead, it may be of iron. 
Particularly is this to be remembered when we find Stockman quoting 
the researches of Mayer, Bidder, and Schmidt, and a host of others, 
who have proved that we are not to look to the kidneys as the path 
for the excretion of iron, but to the intestinal walls. Finally, Stock- 
man has proved that when iron is used hypodermically it cures anae- 
mia when it cannot stimulate the digestion or counteract sulphides. 

We learn from practical experience several things which science 
does not tell us — namely : Iron will not cure all cases of anaemia, 
even if they belong to a functional type, but other methods must be 
resorted to at the same time or separately for their cure. The insol- 



532 DISEASES. 

uble salts of iron are better remedies for absorption than the soluble 
salts, because they are not precipitated in the stomach, and for this 
reason reduced iron is the best chalybeate for uncomplicated cases. 
Besides using iron in this form, we should employ laxatives if the 
bowels are confined ; mineral acids, particularly nitric and nitromuri- 
atic, for their effect on the function of the small intestine and liver ; 
and, in addition, bitter tonics of a more or less simple form, accord- 
ing to the exigencies of the case, using quinine if malaria seems lurk- 
ing in the body, simple bitters if the stomach lacks tone, aromatic 
bitters if from atony of the muscular coats the digestive tract seems 
sluggish, with a resulting formation and accumulation of flatus and 
digestive juices. 

In many cases of anaemia there exists either as a cause or effect 
well-developed intestinal indigestion, and it is thought this results in 
the production of poisons which are responsible for the decrease in the 
corpuscular elements of the blood. The use of laxatives with the 
iron is not only necessary as already stated, but in addition, to over- 
come this production of toxic products, intestinal antiseptics, such as 
salol and beta-naphthol, are found useful. 

The preparations of iron best employed in anaemia are the insoluble 
salts just named, such as Quevenne's iron and the carbonate, but there 
are indications for each salt which must be regarded. In many anaemic 
persons, particularly females, the tongue is broad and white, not from 
coating, but pallor — is flabby and torpid-looking. Under these cir- 
cumstances the bowels should be kept moving by mild purges, and the 
sulphate or some other astringent preparation of iron be taken by the 
patient. In the anaemia caused by rapid childbearing and lactation 
codliver-oil, the hypophosphites and lactophosphates of calcium, should 
be used, while iron and quinine in tonic dose may be also of service. 
"With some practitioners Blaud's pill is very much used, made as 
follows : 

R. — Ferri. sulph. exsiccat. \ -- _--/o A n, 

Potassii carbonatis J 1 ' * ' aa. 3y (8.U). 

Svrupi q. s. — M. 

Ft. in pil. No. xlviii. 
S. — One to three pills three times a day, after meals. 

Although it is perfectly true that we have almost no knowledge of the 
manner in which alteratives act in instances of disease where, through 
morbid functional activity, enlarged glands or growths appear, it is 
evident that they must act upon the trophic nerves or directly upon 
the nourishment of the affected parts. One thing we do know, how- 
ever, and that is that small doses of most of the so-called alterative 
drugs act as very distinct stimulants to the development of normal 
structures, and in no instance do we find this more typically represented 
than in the effect which they exert upon the blood. Quite a number 
of years ago Keyes of New York emphasized the value of minute 
doses of mercury bichloride in syphilitic and other anaemias, and 
abundant clinical observation has certainly confirmed his views. The 
dose of* bichloride of mercury in anaemia should be about -A^ of a grain 
(0.00 16). Not only will minute doses of the bichloride of mercury act 



ANAL FISSURE. 533 

in this way, but small amounts of calomel or mercury itself will have 
such an effect. 

Inunctions of very small amounts of mercurial ointment once a 
day or every other day, in adults and in children, will increase the 
fulness and redness of the cheeks and lips and the number of the 
corpuscles, the piece of ointment used being no larger than the half 
of a very small pea. This treatment will be found of service in cases 
not necessarily dependent upon specific taint or scrofula. The marked 
increase in the nutrition of children of a syphilitic taint who are suf- 
fering from marasmus under the internal use of gray powder and such 
inunction is most extraordinary. 

Arsenic is also of value in anaemic conditions, and may be em- 
ployed in relatively larger doses than mercury bichloride. Many clin- 
icians have shown the value of this drug in anaemia. Any one of the 
preparations of arsenic may be employed, and should the anaemia be 
pernicious in its type, or should it depend upon the disease leukaemia 
or pseudo-leukaemia, the arsenic must be pushed in ascending doses 
until marked evidences of its general effects are manifested. After 
this, however, most of the drug is in excess and is cast off in the urine 
and faeces unused and wasted, straining and irritating the emunctories 
of the body during its passage through them. Arsenic is of particular 
merit in those forms of anaemia in which the blood-cells are lacking 
in number rather than in haemoglobin. 

Arsenite of copper is also a remedy of very considerable value 
under these circumstances in the dose of from -j-Jq- to 2V of a grain 
(0.0006-0.003) three times a day. 

Bullock's blood, fresh or dried and redissolved, may be used by 
the rectum in the treatment of anaemia in those cases where iron 
fails, and a change of air and diet may often produce a cure which no 
drug can bring about. 

Diet is an important part of the treatment of anaemia. The food 
should be good, well flavored, and varied, as well as easy of digestion. 
It should contain, as far as possible, the remedies needed by the sys- 
tem, such as bone salts and iron, and its ingestion should be accom- 
panied by some red wine, such as port. 

At present we are forced to conclude that pathology has not found 
out the real cause of these troublesome cases, and that until physiology 
can put its finger upon the most intricate mechanism of blood-making 
with a positive, clear statement of its function and the physiological 
chemistry of the manufacture of haemoglobin, we must remain satisfied 
to resort to the remedies which experience or common sense tells us 
will be of value to our patients. 



ANAL FISSURE. 

This is one of the most painful affections to which man is subject, 
and requires intelligent treatment, generally by surgical means if the 
result is to be curative, although great relief can be obtained by the 
use of drugs. 



534 DISEASES. 

The most painful and annoying feature of the lesion is the violence 
of the pain on defecation, which is so severe that any emptying of the 
bowel is impossible except on rare occasions, when the pain is concen- 
trated in one effort. 

To relieve this pain and enable the patient to have a fairly com- 
fortable stool, nothing is so good as an iodoform suppository containing 
2 to 10 grains (0.1-0.65) of the drug. Iodoform being a local anaes- 
thetic, the passage takes place almost without the patient's knowledge. 
If much spasm of the sphincter is present, extract of belladonna, ^ 
grain (0.015), may be added to each suppository. For the cure of the 
fissure a drop of strong carbolic acid may be applied to the spot, and 
a lotion of tannic acid, glycerin, and water used if hemorrhoids are 
also present. Ringer highly recommends the application to the fissure, 
by means of a brush, of a solution of bromide of potassium, 1J 
drachms to 1 ounce (6.0 : 30.0) of glycerin. In order that the passages 
may be soft and yet the patient not be purged, sulphur may be given 
in the dose of 20 to 40 grains (1.3-2.6) every night, or, if this cannot 
be used, castor oil may be administered. The best way to give the 
sulphur is by combining it with powdered cinnamon or aromatic 
powder. 

Sometimes relief is obtained by the use of flexile collodion painted 
over the fissure. 

ANEURISM. 

The treatment of aneurism by drugs is. unfortunately, not very suc- 
cessful, but is at least worthy of trial in all cases. Vascular disease 
resulting in such a lesion depends upon so many causes which may 
modify the treatment that the history of the case should be carefully 
considered. The most common causes are syphilis and traumatism, and 
very often injury is superimposed upon one of the systemic taints. 
Whatever the cause of the disease may be, iodide of potassium is par 
excellence the remedy most apt to do good, even if it does not cure. 
The doses should be large, 10 to 20 grains (0.65-1.3) three times a 
day if the patient will bear them, and the prognosis under this treat- 
ment is far more favorable if the cause be syphilis than if the disease 
be purely idiopathic or traumatic. 

For successful treatment the recumbent position must be insisted 
upon, the patient being kept quiet in bed, changing his position as 
little as possible and confining himself to the most simple and easily 
digested diet, with entire avoidance of all stimulating substances either 
in the way of food or drink. Often it is best to adhere to an absolute 
milk diet. If the heart is excitable and irregular in its action, the 
vascular system irritable, and a high arterial tension is present, the 
circulation must be quieted by small doses of veratrum viride, say 1 or 
2 minims (0.05-0.1) twice or thrice a day, but digitalis is not to be 
employed, since it increases the strain upon the aneurismal sac, although 
it quiets the irregular heart beat. Aconite may also be used with 
care, but it is inferior to veratrum viride. Tf the pain be very great 
— and it often is severe, particularly at night — opium is indicated, and 



ANGINA PECTORIS. 535 

sleeplessness should be allayed, not by full doses of morphine alone, 
but by morphine and chloral ; or, better still, croton-chloral should be 
so ordered that the patient receives \ grain (0.075) of morphine and 
10 grains (0.65) of croton-chloral in pill at bed-time. All attempts 
to cure aneurism by the use of other drugs, unless syphilis ^ indicates 
mercury, are useless when the lesion is thoracic or abdominal : and 
when it occurs in the extremities, as in popliteal aneurism, pressure 
or surgical measures are to be resorted to as the chief means of cure. 
If dyspnoea is marked in thoracic aneurism, slight inhalations or 
" whiffs " of chloroform are sometimes useful. 

Recently a number of French physicians, chiefly Lancereaux, 
Huchard, and Carnot, have recorded good results in hastening the 
formation of clots in the aneurismal sac by injecting a solution of 
gelatin into the subcutaneous tissues in other parts of the body. The 
formula used is as follows : 

Gelatini gr. xxx (2.0). 

Sodii chloridi gr. cl (10.0). 

Aquse destillat fgiv vel f|x (120.0-300.0). 

About 2 ounces (60.0) of this are injected every second day into 
the loose tissues of the back or thighs, a different spot being chosen 
each time. About twenty injections are necessary before marked 
results are obtainable, and absolute rest should be insisted upon. The 
solution used should be, of course, carefully sterilized. (See Hemor- 
rhage.) 

The author has performed the operation of introducing gold wire 
and using electrolysis in thoracic aneurism a number of times, with 
great benefit to the patient. The operation is indicated in case of 
sacculated aneurism, but never in the fusiform type. 

ANGINA PECTORIS. 

The exact pathological changes existing in angina pectoris are by 
no means clearly understood, but without doubt many cases are due to 
spasm of the blood-vessels, which results in distention of the left side 
of the heart, which organ is already dilated or enfeebled by disease. 
Often, too, the coronary arteries have undergone degenerative changes, 
thereby increasing the cardiac debility. Remedies which ordinarily 
relieve pain act too slowly or too feebly to be of service in angina pec- 
toris, and even if successful would only relieve the symptom without 
removing the cause. The indication in the great majority of cases is 
to relax the vascular spasm, thus relieving the overburdened heart. As 
first pointed out by Brunton, the nitrites possess this power, and to him 
belongs the credit of first applying this class of drugs to this ailment. 
All the nitrites are useful, but the nitrite of amyl and nitroglycerin 
are the best remedies for the attack itself, and the nitrite of potassium or 
sodium for the intervening periods or when the paroxysm is prolonged. 
The reason for this lies in the fact that the sodium and potassium 
compounds are more stable than the other two compounds, are more 
slowly broken up in the body, and therefore more prolonged in their 



536 DISEASES. 

effects. In an attack a few drops of the nitrite of amyl should be 
given by inhalation from a handkerchief, or the nitroglycerin can be 
used in the dose of 1 minim of a 1 per cent, solution by the mouth. 
The dose of the sodium and potassium nitrites is 3 grains (0.15) three 
times a day, but all these drugs are useless unless the arterial tension 
is high and the heart throbbing or irregular. 

If vascular relaxation is present, the nitrites should be supplanted 
by stimulants, such as alcohol, in full dose, in warm water. Digitalis 
tincture in the dose of 10 minims (0.65) may be given hypodermically 
during the attack to stimulate the heart if it is weak, and between the 
attacks to improve its condition administered by the mouth. The 
writer has found 20-grain (1.3) doses of antipyrin of great service in 
some cases. Ether given hypodermically is often of service, but 
Hoffmann's anodyne may be used instead of ether by the mouth or 
hypodermically with better results. 

If the nitrite does not relieve the pain, or if it cannot be used 
because of some contraindication, morphine must be given hypoder- 
mically in the dose of J to \ grain (0.016-0.03), but it should never 
be given by the mouth under these circumstances, as its absorption 
will be too slow and its effects will come on after the pain has ceased. 

The cure of the patient rests upon the elimination of all causes which 
can possibly produce a nerve-storm from cardiac irritability, and in the 
administration of arsenic in full dose for long periods of time. Phos- 
phorus is another remedy which is of undoubted value, and should 
always be tried in the dose of y^- grain (0.0006) three times a day 
after meals. 

The following is a valuable prescription for use between the attacks : 

R.— Tine, digital T^xlviij (3.0). 

Tine, strophanthi ffLxlviij (3.0). 

Nitroglycerin! (1 per cent.) rr^xxiv (1.6). 

Tine, cardamomi q. s. f^iij (90.0). — M. 

S. — Teaspoonful (4.0) three times a day. 

The diet should be moderate and easy of digestion, and salads, 
lobster, and similar articles of food avoided. If the patient is in- 
clined to take exercise of a violent character he must be restrained, 
but, on the other hand, some exercise must be insisted on if it is pos- 
sible to take it without precipitating an attack. 

Tonics, fresh air, freedom from mental worry and avoidance of 
exposure and cold are also necessary, and running for a car, or per- 
forming any act calculated to suddenly increase arterial pressure and 
cardiac work, is to be avoided. 

In that form of angina pectoris occurring in nervous females, some- 
times called pseudo-angina pectoris, 1 drachm of ether in ice-water or 
capsule will often abort the attack, or if the paroxysm is caused by 
dyspepsia and if the stomach be overloaded, the "sufferer may be 
relieved by the stomach-pump. Between the attacks aconite tincture 
in the doses of 2 to 3 minims (0.1-0.15) three times a day is useful. 



ANOREXIA-APOPLEXY. 537 



ANOREXIA. 



Anorexia, or lack of appetite, is only a symptom of disease, gen- 
erally associated with debility or other systemic disorder, such as 
anaemia, fever, and many exhausting diseases. 

It is best treated by a careful, well-cooked, and daintily-prepared 
diet, the use of the bitter tonics, such as gentian, cardamoms, and 
the mineral acids, or by the use of one of the following prescrip- 
tions : 

R. — Acid, arsenosi gr. ^ (0.03). 

Extract, nucis vomicae gr. iv (0.3). 

Quinina? sulph. gr. xx (1.3). — M. 

Ft. in pil. No. xx. 
S. — One t. d. after meals. 

Or, 

R.— Acid, hydrochlorici dil fgss (16.0). 

Tinct cinchona? comp ffvj (180.0). — M. 

S. — Dessertspoonful (8.0) three times a day, after meals, well diluted with water. 

(For the use of other bitter tonics see Calumba, Quassia, Chamo- 
mile, Cardamom, and Nux Vomica. None of these drugs are suit- 
able if there is any acute irritation or inflammation of the stomach 
or intestines. (See Indigestion.) 



APOPLEXY. 

When a person suifers from a stroke of apoplexy, the chief aim of 
the physician must be to lower the blood-pressure if it be high, and so 
to decrease the intracranial hemorrhage, and, as the blood-pressure is 
nearly always excessive under these circumstances, its reduction may 
be considered as a routine treatment if the patient is seen very soon 
after the onset of the attack. If the person be full-blooded, copious 
venesection is to be employed upon any one of the veins in the arm on 
its anterior surface. (See Venesection.) At least 1 pint (500 cc.) of 
blood should be withdrawn and the condition of the pulse carefully 
noted. If bleeding is impossible, veratrum viride or aconite must be 
used to lower blood-pressure, the latter in full dose, 5 minims (0.35) of 
the tincture. Hot mustard plasters must be applied to the feet, or a hot 
mustard foot-bath be used if this is practicable. Ice in an ice-bag or 
wrapped in a towel may be applied to the head. If vomiting comes on, 
care must be taken that the stertorous breathing does not draw into the 
lungs particles of the half-ejected food. Sometimes croton oil, 1 minim 
(0.05), placed on the tongue with 5 minims (0.3) of sweet oil may cause 
a depletant catharsis which will relieve cerebral engorgement, or J grain 
(0.01) of elaterium may be used. The head must be kept high and 
the feet low down. These are the methods to be used immediately after 
the rupture of the blood-vessel. 

The object to be sought, after the "stroke" has occurred and the 
hemorrhage has ceased, is the removal of the extravasated blood, the 
restoration of function in the paralyzed parts, and the prevention of 
secondary lesions consequent upon inflammation of the brain as a 
result of the injury to its substance. If the patient survives the 



538 DISEASES. 

attack, no drugs should be used save arterial sedatives for one or 
two days, until the clot in the ruptured vessel has become firmly 
fixed, unless symptoms of meningitis arise, when these drugs must 
be pushed if the pulse is tense, and calomel administered in small 
antiphlogistic doses, \ grain (0.016) of each every four hours. After 
the clot has firmly formed and has plugged the blood-vessel, we may 
proceed to take measures for the absorption of the exudate, the chief 
measure consisting in the use of iodide of potassium in as large doses 
as the patient will bear without the production of iodism. This drug 
should not be resorted to until several days, or even two or three weeks, 
have elapsed after the attack. Mercury in small doses may also be given. 

In order that the muscles of the extremities may not waste and 
become powerless from disuse, passive exercise, rubbing, and, if pos- 
sible, massage, must be resorted to. Electricity may be applied to 
them in the form of the slowly-interrupted current, and strychnine 
may be used hypodermically or by the mouth as a stimulant to the 
trophic centres in the spinal cord. None of these measures are to be 
employed if any inflammation exists in the brain, as they will increase 
the cerebral disorder, and at least three weeks should elapse after the 
attack before they are resorted to. (See Strychnine.) 

Electricity applied to the head to remove the lesion is useless, as 
the current does not go through the brain, but around the skull by 
means of the scalp. 

A very careful diet is to be maintained. Meats are to be used 
very sparingly, the bowels maintained in perfect regularity, and no 
wines are to be taken nor any stimulants used, lest they cause a 
second rupture of the weakened vessel in the brain. 

Apoplexy must be carefully differentiated from acute alcoholism 
and opium poisoning, which it much resembles. (See Alcohol.) 

If respiration fails, nothing can be done with much advantage, but 
belladonna or strychnine may be given hypodermically. The use of 
electricity to stimulate the phrenic nerve and diaphragm when respi- 
ration fails is a remnant of senseless medical practice, and is partic- 
ularly useless in apoplexy. (See Asphyxia.) 

Above all things, stimulants are contraindicated during the acute 
attack, even though the pulse fails, as they increase the hemorrhage 
into the brain. 

If the symptoms of apoplexy are produced by an embolus, bleed- 
ing is usually useless, and it may be harmful by decreasing arterial 
pressure and thereby delaying the establishment of collateral circulation. 

APPENDICITIS. 

It is to be remembered that many cases which years ago would 
have been called idiopathic peritonitis are now recognized as arising 
primarily from inflammation of the appendix vermiformis. For this 
reason it is incumbent upon every physician who is called to see a case 
of severe abdominal pain with symptoms of peritonitis or appendi- 
citis to carefully examine into the condition of the appendix. No 
routine treatment for appendicitis can be followed, as each case pos- 



APPENDICITIS. 539 

sesses distinct individuality. There are many surgeons, holding ex- 
treme views, who assert that the mere presence of appendicular 
inflammation for a few hours renders an extirpation of this organ 
necessary. On the other hand, there are doubtless many cases in which 
the physician postpones consultation with a surgeon until it is too late 
to save the patient. All cases of appendicitis may be divided into 
three classes : First, those which are fulminating or gangrenous, and 
almost invariably result in death whether treated medically or surgi- 
cally ; second, those which need surgical interference ; and third, 
those which undoubtedly get well, some of them permanently so, 
under proper medical treatment. With the first class we shall not 
deal, for obvious reasons. In all cases of acute appendicitis of the 
third class which we have named the method to be followed is briefly 
as follows : The patient is to be put to bed and absolute rest on the back 
insisted upon. He must not rise to the sitting posture even for defe- 
cation or urination. An ice-bag is to be placed over the appendix, 
or, if this cannot be done, leeches may be applied in this region. The 
bowels may be moved by half to one ounce of magnesium sulphate or 
citrate of magnesium in its official solution, but it is far better to unload 
the colon by rectal injections. After the bowels have been moved, 
sufficiently large doses of opium or morphine are to be given to relieve 
pain and act as an antiphlogistic. The doses should be of such size as 
to " take the edge off the pain," but they must not stupefy the patient, 
so that he fails to give clear answers to questions. If in spite of this 
treatment there is persistent tenderness in the right iliac region, with 
increase in the area of dulness on percussion over the appendix, and a 
sense of deep-seated tension exists, then a surgeon should be at once 
called in — not, necessarily, to operate, but to decide as to the advis- 
ability of an operation, and to perform it if it is considered a wise pro- 
cedure. Generally, it is best to postpone surgical interference in mild 
cases until after the acute attack is over, but this preference is to be 
waived in pressing cases, when there is rigidity of the belly and great pain. 

In the second class of cases which we have named the treatment is 
too largely surgical to be considered in a book devoted only to medical 
therapeutics. It is unnecessary to give a purgative before the opera- 
tion, unless w T e think the bowel contains undigested food, since the caput 
coli never contains faeces in any quantity, and furthermore, in those 
fairly severe cases which demand operation at once the possibility of 
perforation of the appendix, with escape of the contents of the bowel 
into the peritoneal cavity, is always to be remembered, for if perfora- 
tion has occurred the purgative will force the faeces out through the 
patulous appendix. 

Instead of a milk diet, the patient should receive a diet of broths or 
beef-tea, since the casein in the milk is apt to cause fermentation and 
the formation of gas in large amounts in the intestine, thereby causing 
distressing tympanites. 

If attacks of appendicitis are recurrent, the appendix should be 
removed in an interval of quiescence. (See article on Peritonitis.) 



540 



DISEASES. 



ASPHYXIA. 



When practising artificial respiration in cases of asphyxia Sylves- 
ter's method should always be employed. This consists of laying the 
patient on some hard, flat surface, kneeling above his head, and then, 
after grasping the arms at the elbows, bringing them upward and 
outward, so that they follow the plane on which the body is extended. 



Fig. 96. 




Sylvester's method of artificial respiration. First method : the patient's arms are placed at 
right angles to the trunk, the elbows resting on the floor, to expand or inflate the chest. 

This movement causes expansion of the chest, or inspiration. After 
a moment's pause the arms are lifted up and brought toward one 
another, and then, while still approximated, pushed down to their 



Fig. 97. 



» 



Sylveste 



sthod <>r artificial respiration. Second movemenl : the patient's arms are drawn 
toward the physician, in order to still further expand the chest. 



original position upon the floating ribs, upon which they are pressed. 
Tins last movement drives out the air from the chest, or causes expu 
ration. These movements should be at the rate of from sixteen to twenty 



ASPHYXIA. 



541 



per minute, about that of normal respiration, and be persisted in for 
at least forty-five minutes, even though the case seems hopeless, as 
cases have recovered after as long a period of apparent death as an 



Fig. 98. 




Sylvester's method of artificial respiration. Third movement: the patient's arms are raised 
and the elbows approximated to contract the chest. 

hour. While these movements are being carried on, the patulousness 
of the upper air-passages is to be maintained, if possible, by the measures 
described below, 

Fig. 99. 




Sylvester's method of artificial respiration. Fourth movement : the patient's elbows and fore- 
arms are pressed forcibly upon the floating ribs to expel the air from the chest. 



In some researches made by Dr. Martin and the writer the follow- 
ing rules regarding the position of the head, neck, epiglottis, and 
tongue were formulated: The fingers are passed behind the angles 
of the lower jaw and the latter is pressed forward ; this elevates the 
epiglottis and the base of the tongue about a quarter of an inch from 



542 



DISEASES. 



the post-pharyngeal wall. Extending the head and pushing it for- 
ward so that the neck makes an angle of forty-five degrees with the 
plane of the table draws the base of the tongue and the hyoid bone 
far forward, this motion being at the same time imparted to the epi- 



Fig. 100. 




Showing the attitude in which the head should be held to permit the easy passage of air 
through the glottis. This position raises the epiglottis, and lifts the soft palate from the 
tongue. (Martin and Hare's method.) 

glottis, so that the latter stands upright and is separated from the 
posterior wall of the pharynx by an interval of about an inch. By 
tightly closing the jaw the antero-posterior space is still further 
increased. 

Fig. 101. 




Tins figure Illustrates how upward traction on the tip of the tongue draws the epiglottis awar 
from the glottic opening and permits free; Ingress of air. it also shows how letting the 
tongue fail back In the mouth in anasthesin would close the air- passages and permil the 
epiglottis to Interfere with breathing. (From a research by Dr. Martin and the author.) 



A very useful metho< 
rhythmic traction of 



in treating asphyxia is Laborde's method by 
is grasped with forceps 



le tongue. 



The tongue 



ASTHENOPIA. 543 

and pulled well forward and upward from ten to fourteen times a minute 
until voluntary respirations occur. The sensory nerves of the tongue 
carry impulses to the phrenic centre, which in turn causes the diaphragm 
to contract. A very large number of recoveries from apparent death 
as a result of its use renders this method most worthy of trial. 

The absurdity of the application of the rapidly interrupted electric 
current to the phrenic nerve is not alone dependent upon the points we 
have named. (See Ether.) It has recently been proved by careful ob- 
servation on the part of Dr. Martin and the, author that the application 
of the electrode over the phrenic nerve in the neck may cause cardiac 
arrest through diffusion of the current to the vagus nerve, and Griswold 
reached conclusions of an identical character in 1885. 

If electricity is used, it should be employed solely as a peripheral 
irritant, with the object of arousing the patient, as would a dash of 
cold water. 

ASTHENOPIA. 

Asthenopia, or weak sight, depends upon exhaustion of the power 
of accommodation in cases of refractive error, usually hypermetropia, 
or upon insufficiency of the external ocular muscles. The former is 
sometimes called accommodative asthenopia, and the latter muscular 
asthenopia. The treatment of these conditions requires the prescrib- 
ing of the proper pair of glasses, combined, if necessary, with prisms 
and with systematic exercise of the ocular muscles. Locally, a weak 
solution of the sulphate of eserine or pilocarpine acts as a stimulant 
to the ciliary muscle, and good results follow the internal use of 
large doses of the tincture of nux vomica or strychnine. 

R .— Eserinse sulph. . \ . . gr. ^ (0.002). 

Aq. destill f£j (30.0)— M. 

S. — 2 drops (0.1) night and morning. 

Or, 

R.— Pilocarpin. nitrat gr. & (0.003). 

Aq. destill f^j (30.0).— M. 

S. — 2 drops (0.1) night and morning. 

Another form of asthenopia is termed neurasthenic asthenopia or 
retinal anaesthesia, and presents a number of eye-symptoms in con- 
nection with a general depression or debilitated state of the nervous 
system, the eye, itself, however, being a healthy organ. The chief 
symptoms are fluctuation in visual acuity, rapid disappearance of 
objects looked at, contraction of the field of vision, imperfect retinal 
images, often associated with dread of light. The mere prescription 
of glasses in these cases to correct any refractive error is not suf- 
ficient. Much relief will often be obtained if hot compresses at 110° 
F. be made to the closed eyelids for five minutes at a time. The 
patient requires the same general treatment that would be applied to 
any neurasthenic case. All the functions of the body must be care- 
fully examined into and placed in as normal a condition as circum- 
stances will allow. Especially valuable are rest, massage, salt baths, 
and full doses of strychnine, together with iron if there be anaemia. 



544 DISEASES. 



ASTHMA. 



Asthma is one of the most difficult diseases to successfully treat 
that the physician has to deal with. 

The disease in all its forms depends upon interference with the 
free entrance to and exit of the air from the lungs, and this is gen- 
erally, if not always, dependent upon a spasm of the muscular fibres in 
the walls of the bronchial tubes, although it has been asserted to be 
due to a sudden swelling or hyperemia of the bronchial mucous mem- 
brane. Both of these states are probably present in varying degree 
in all cases. 

The spasm has been proved by Longet, Williams, Romberg, Paul 
Bert, Bierner, and more recently by Sandmann, to be due to a neurosis 
of the pneumogastric or vagus nerve, while the swelling of the mucous 
membrane has been seen by Stoerk and others. This has formed 
two schools of teaching concerning the pathology of this disease, 
when a little attention to the physiology of the subject would at least 
show that no difference need exist, the vagus nerves governing not 
only the muscular fibres, but also the blood-vessels of the bronchial 
tubes. The discovery of Michaelson that injury of the recurrent 
laryngeal nerves causes catarrhal inflammation of the bronchial tubes, 
particularly those of the upper lobes, renders the analogy between 
acute asthma and laryngeal spasm which has been spoken of by 
many writers still more interesting. 

One other step remains for a thorough understanding of the man- 
ner in which the disease is produced. Gastric, dyspeptic, or intestinal 
asthma arises from indigestion, as its name implies, and is caused by 
the irritation of the afferent filaments of the vagus in the walls of 
the stomach and intestine, thereby causing reflexly a contraction and 
hyperemia of the bronchial tubes. In a similar reflex manner hyper- 
trophies of portions of the nasal chambers or abnormal conditions of 
the nasal mucous membranes in general may result in an asthmatic 
attack. 

Having obtained some idea of the cause of an attack, let us turn 
to the treatment of the affection. 

One of the most serviceable remedies in asthma is belladonna, which, 
as has been pointed out when that drug was studied (see Belladonna), 
exercises in medicinal dose a decided sedative and depressing influ- 
ence on the peripheral filaments of the vagus nerves, not only so far 
as the heart is concerned, but also, through the pulmonary fibres, upon 
bronchial secretion, which is always diminished by the drug, probably 
by this vagal influence. 

It is evident, therefore, that the use of belladonna or atropine, 
although originally employed in an empirical manner, rests upon a 
rational basis, and as the physiological action of stramonium, hyoscy- 
amus, and similar members of this group is nearly identical with 
belladonna, their influence for good is also explained. The experi- 
ments of Ott prove that lobelia is a peripheral pneumogastric de- 
pressant, and tho.se of Rosenthal and the author likewise showed 
that tobacco has a similar effect. The same is also true of nitrite of 



ASTHMA. 545 

amyl and the other nitrites, which also relax unstriped muscular 
fibre. We have before us, therefore, a list of the most efficacious 
and best antiasthmatics, all of them being depressant to the periph- 
eral vagi. 

The other remedies commonly employed are chloroform by inhala- 
tion, which relaxes the spasm of muscular fibre by its local influence, 
and morphine, which acts as a nervous sedative, prevents reflex irri- 
tation, and quiets the patient, acting at the same time as a heart stim- 
ulant and unloading the engorged cardiac cavities. The relief obtained 
by the inhalation of the fumes of nitrate of potassium, See asserts, 
depends upon the formation of the protoxide of nitrogen and carbonic 
acid gas, which act as local anaesthetics. 

The practical treatment of an attack of asthma consists in the use 
of morphine hypodermically in the dose of -^ to J grain (0.01-0.015), 
alone or in combination with atropine. Cigarettes made of paper 
soaked in a solution of nitrate of potassium and belladonna may be 
smoked (see formula under Belladonna), or they may be made in the 
following manner : 

R. — Foliorum belladonnas gr. vj (0.36). 



Foliorum hyoscyami 
Foliorum stramonii 
Extracti opii . . . 
Aquas lauro-cerasi . 



gr. iij (0.2). 
gr. iij (0.2). 
gr. 1 (0.015). 
q. s— M. 



These various leaves are broken up like commercial tobacco, and 
moistened by adding the cherry-laurel water, which should contain 
the opium. Finally, a whole leaf soaked in the same fluid is used as 
a cover, or a piece of cigarette paper may be employed in the same 
manner. 

In some cases a very useful treatment is the smoking of nitre- 
paper cigarettes, which are prepared, before rolling, not only by soak- 
ing the paper in a solution of nitrate of potassium (see Nitrate of 
Potassium), but also by dipping them, after drying them, in tincture 
of belladonna or stramonium, and allowing the alcohol to evaporate 
from the paper while it is hung in the air. 

Another remedy recently brought forward in this country for the 
relief and cure of asthma is euphorbia pilulifera, the fluid extract of 
which may be given in the dose of J to 1 drachm (2.0-4.0) once, twice, 
or thrice a day. (See Euphorbia Pilulifera.) 

The author finds the following formula very useful in asthma : 

R. — Sodii iodidi gr. ij (0.1). 

Potas. bromidi gr. ij (0.1). 

Ext. euphorbias pilulifera? fl n^iij (0.15). 

Nitroglycerin! gr. ^h (0.0003). 

Tr. lobelias rr^ij (0.1).— M. 

Ft. in tabel. vel capsul. No. i. 
S. — From 1 to 4 three times a day. 

If desired, this formula may be given in the form of an elixir. 
It will be seen that each ingredient of this recipe has a different action. 
The action of iodides in asthma is well known, as is also that of the 
bromides. The euphorbia pilulifera has been found useful in asthma 
empirically. The nitroglycerin depresses the peripheral ends of the 

35 



546 DISEASES. 

vagus nerves, and acts as a stimulant to the heart when engorged with 
blood by removing the inhibitory action of the vagus and relieving the 
blood-vessels elsewhere. The tincture of lobelia acts as a depressant 
to the vagus also. 

A valuable prescription for asthmatics to take between the attacks, 
particularly in those cases which have cardiac symptoms, is the one, 
calling for digitalis, strophanthus, and nitroglycerin, in the article on 
Angina Pectoris. 

Sometimes a cup of strong coffee taken at the beginning of a 
paroxysm will abort it. 

The use of amyl nitrite by inhalation, 3 to 6 minims (0.15-0.4) on 
a handkerchief, is invaluable in many cases, and it rarely fails to 
relieve the spasm. Owing to the engorgement of the heart conse- 
quent upon the embarrassment of respiration, this nitrite must be used 
with care, and in one or two instances it has proved dangerous by 
causing cardiac failure. 

Sometimes tobacco may be smoked, and it is particularly efficacious 
in those who are not accustomed to its constant use. 

Lobelia when employed should be used in full emetic dose (1 
drachm [4.0]), in the form of the tincture if an attack is imminent. If 
an attack is feared, 10 minims (0.65) of the tincture every four hours 
may be given if the heart is in good condition. 

A treatment of asthma which is very successful when it arises from 
nasal disorder consists in the application to the nasal cavities, at the 
onset of the attack, of the following solution by means of a brush or 
spray : 

R. — Cocain. hydrochlorat gr. xv (1.0). 

Aqua; destillat. . q. s. ad f£iv (16.0) — M. 

S. — Apply as directed. 

If this solution is thoroughly applied and the other directions given 
are carried out, very rapid relief will often be obtained. Unfor- 
tunately, we cannot readily separate those cases which are due to 
nasal disease and those produced by other causes, and in consequence 
this treatment when tried for the first time in a given case is purely 
experimental unless we can discover some hypergesthetic patch in the 
mucous membrane. 

The curative treatment of asthma to a very large extent rests 
upon the use of iodide of potassium, and in the careful regulation of 
the diet and bowels, particularly if the trouble seems to be dependent 
upon indigestion. As the attacks are generally nocturnal, the even- 
in g meal should be taken early, be light and easily digested, and tea 
and coffee should be avoided at this time. The patient should avoid 
dusty streets and live in the open air as much as possible, and a damp 
atmosphere is usually preferable to a dry one, provided it is not too 
cold. This rule is subject to many variations, and each case will be 
found to be a law unto itself. Each patient must try different climates 
until the proper one is found. Arsenic may be used, particularly if 
the mucous membranes are below par, and a dose of bromide of potas- 



BED-SORES. 547 

sium or sodium, 30 grains (2.0) half an hour before retiring to bed, may 
be of service. 

Grindelia robusta is largely used as a prophylactic in the dose of 10 
to 30 minims (0.65-2.0) of the fluid extract three times a day. Lobe- 
lia may also be used in the form of the tincture, 10 minims (0.65) three 
times daily. 

The use of compressed and rarefied air is sometimes of service. 
Inhalations of oxygen are valuable if the cyanosis is extreme. 

In many cases the greatest relief will be given by the use of the 
bronchitis tent. (See Bronchitis.) 

In those cases in which the presence of nasal polypi or other irrita- 
tions of the air-passages is the provoking cause of the attacks those 
causes must be removed before a cure can be attained. In other 
instances arsenical wall-papers are the cause of the trouble. In all 
cases of asthma the physician should from time to time examine the 
urine and the heart. 

BED-SORES. 

Bed-sores depend upon disturbances of nutrition resulting from 
pressure exercised in such a manner that the local circulation is inter- 
fered with at a time when the vitality of all of the tissues is depressed 
by disease or injury. In most instances the part involved becomes 
chafed by creases in the sheets, by crumbs of food, or by moisture 
from the discharges of the rectum and bladder. They can usually be 
avoided by cleanliness unless dependent upon disease of the trophic 
nervous system, 

The chief thing to be done is to prevent the trouble by careful 
nursing and cleanliness, which must be supplemented by measures 
devoted to the hardening and improving of the skin covering the parts 
where the sores are apt to appear, as over the buttocks and sacrum. 
To permit of a good supply of blood, the patient should be turned on 
one side or the other every few hours and the skin of the part which 
has been pressed upon rubbed thoroughly with a dry towel to cause a 
healthy transudation and absorption of the nutritive juices. Salt and 
whiskey, 2 drachms (8.0) to the pint (500.0), may be rubbed over the 
skin, and tincture of catechu or the dilute solution of the subacetate of 
lead applied to harden it. If this is not used, a mixture of alum and 
spirit of camphor is useful, made by adding 1 ounce (30.0) of pow- 
dered alum to the whites of 4 eggs and mixing this with 2 ounces (60.0) 
of the camphorated spirit. Where the skin is very red and angry- 
looking, but still intact, a solution of nitrate of silver of the strength 
of 20 grains to 1 ounce (1.3 : 30.0) is to be thoroughly painted over the 
spot. All these remedies act by hardening the skin through their 
astringency, or by acting as sedative astringents to the inflamed but 
relaxed capillaries of the part. 

When a bed-sore is developed measures must be taken for its cure 
and the prevention of its spread. With this object in view the body 
must not rest on the part affected if this can possibly be avoided, and 
in order that the sore may be protected and the pressure equalized, a 



548 DISEASES. 

large piece of soap-plaster, with its edges deeply incised to make them 
pliable, should be applied after the s6re has been thoroughly washed out 
by means of a swab or syringe filled with a 1 : 5000 solution of bichloride 
of mercury, and afterward dusted with iodoform. Sometimes large 
squares of lint heavily covered with zinc ointment are serviceable in 
lieu of the soap-plaster. If the sores spread and burrow through the 
parts, the sinuses should be freely opened and irrigated with peroxide 
of hydrogen, all dead tissues being cut away to avoid sepsis. 

Nitrate of silver in the strength of 20 grains to the ounce (1.8 : 30.0) 
may also be used locally as the patient recovers if the ulcers seem 
sluggish. A smooth slip-sheet should always be placed under the 
buttocks. If possible, supportive measures and an increased amount 
of predigested food should be given if the sloughs are large. The 
internal use of iron is particularly valuable in the form of the tincture 
of the chloride in full doses (say 20 minims [1.3]) every four hours. 



BILIOUSNESS. 

This is a term used to designate a state which presents different 
symptoms in different cases, but always includes languor, headache, or 
dizziness, perhaps some yellowing of the skin and conjunctiva, and a 
general sense of atony, mental depression, and discomfort. It depends 
not upon an excessive secretion of bile, but upon some perversion of 
the functions of the liver or the retention of bile in the bile-ducts. 
Further than this, most of the symptoms do not depend directly upon 
the changes in the bile, but upon failure of proper digestion in the 
stomach and intestine, coupled with the development of irritative decom- 
position-products of various kinds. The stomach, intestine, liver, pan- 
creas, and their juices all form a complex interwoven chain of function 
in which if one link breaks the entire chain becomes disturbed. The 
entrance into the stomach of certain food-stuffs which are either ill 
prepared or improper for gastric digestion rapidly causes the develop- 
ment of active fermentation, with the formation of lactic and butyric 
acids, which irritate the gastric mucous membrane, and thereby bring 
about a faulty gastric secretion of mucus, which makes still further 
trouble. By the same means the circulation of the stomach is dis- 
turbed and becomes abnormal, and the intestine, liver, and pancreas 
receive reflex irritation to which they are not normally exposed. Further 
than this, the irritated stomach fails to convert its contents into pep- 
tones and the general features of chyme, and too early or too late 
diives out into the duodenum a mass of semi-digested and fermenting 
material utterly unfit for intestinal digestion and absorption, thereby 
disordering the functions of these parts still further at a time when 
they are not prepared for the reception of any food. The secretion 
poured out by the different glands varies from the normal; the alka- 
line juices are not able to overcome the normal acid of the gastric 
juice plus tlio laetie and butyric acids; and finally the reaction of 
the intestine becomes acid instead of alkaline, witli resulting irrita- 
tion and secretion of* morbid juices and mucus. The trouble when 



BILIOUSNESS. 549 

existing in the stomach gives rise to headache and discomfort, a bad 
taste in the mouth, and perhaps pain, and is followed by fever, lan- 
guor, jaundice, and flatulence when the intestine is affected. The 
cause of these symptoms rests upon the fact that, while gastric juice 
and bile are antiseptic, pancreatic juice mixed with food undergoes 
rapid decomposition, with the development of products of decomposi- 
tion, such as skatol and indol and a large number of poisonous alka- 
loids. Normally, these are not allowed to form, owing to the pres- 
ence of antiseptic bile, which also hurries on the absorption of the 
food ; but if the bile is retained in its ducts, its secretion is impaired 
and its constitution altered by the disorder of the liver which results 
reflexly from the gastric and intestinal irritation. Unfortunately, 
the complication does not cease at this point, for the liver in health 
has other functions to fulfil, one of the most important of which is 
the arrest and destruction of all poisons of an organic character which 
come to it from the stomach and bowel. Not only are decomposition- 
products destroyed by it, but all the vegetable alkaloids are rendered 
innocuous if present in ordinary amounts. 1 The disorder of hepatic 
function, therefore, permits the entrance into the general circulation 
of these substances, which are very various as regards their powers 
and effects. Thus, B run ton has pointed out that one of these com- 
pounds closely resembles curare, in that it poisons the peripheral ends 
of the motor nerves, and thereby is at least partly responsible for the 
muscular relaxation and languor often seen in patients suffering from 
so-called "biliousness." Other substances act as do digitalis, atro- 
pine, muscarine, and picrotoxin, and the number of these various 
compounds is infinite. 2 

It is impossible to give space to a further consideration of these 
poisons, but what has been said shows clearly that "biliousness" 
only expresses a state in which absorption of the bile is not the sole 
cause of the symptoms, but that other poisons are at work. The 
methods of treating biliousness are therefore not to be considered as 
depending upon some regular routine, but upon a study of the case 
and its symptoms. 

Very frequently, after several days of minor discomfort, the disorder 
culminates in a severe sick headache, after which vomiting comes on 
and relief is obtained almost at once. Such patients can generally 
be relieved in the very first part of their discomfort by emetic doses 
of ipecac or apomorphine, 30 to 60 grains (2.0-4.0) of the former, or 
■^ grain (0.004) of the latter hypodermically. The manner in which 
this treatment does good is very evident. It compresses the liver and 
expels inspissated bile by the compression exercised by the abdominal 
walls and diaphragm in the effort of vomiting, and thoroughly excites 
to normal secretion the torpid glands of the stomach and intestine. 

The vomiting also rids the stomach of the fermenting masses and 
bacteria contained in them, and renders the alimentary canal more pure. 
This purity may be increased by giving between the paroxysms of 

1 See studies of Schiff, Lautenbach, and many others, including Ludwig and 
Schmidt-Mulheim. 

2 See the researches of Schweringer, Zuelzer and Sonnerscheim, Bence Jones, 
Dupre, Eorch and Fassbender, Brieger, Schmiedeberg, and Harnach. 



550 DISEASES. 



vomiting by draughts of warm water or water containing a few grains 
of bicarbonate of sodium or salicylic acid. 

When it becomes evident that an attack is about to begin — that is, 
when constipation, slight drowsiness, or languor after meals shows 
the tendency present — one of two drugs should be used, either podo- 
phvllin if the stools be dark, or calomel if they be light-colored : 
J grain (0.01) of the former to an adult is generally enough, or 1 grain 
(0.05) of calomel divided into six powders, one of which is to be taken 
every fifteen minutes, is a good dose, to be followed in four hours by 
a saline. If the attack is sudden in its onset, no time is allowed 
for these hepatic stimulants, and a saline purge should be used in a 
good-sized dose at once, not because it causes a flow of bile, but 
because it sweeps the poisonous matters out of the gut before com- 
plete absorption can occur, and aids in restoring the normal intestinal 
alkalinity. 

The prevention of "biliousness" depends upon the maintenance 
of a normal, easily digested diet, upon the formation and excretion 
of normal bile, and the prevention of fermentation and decomposition 
in the alimentary tract. 

The term " normal diet " is a very elastic one, and varies with each 
case. While certain forms of food are generally considered good or 
bad. easy of digestion or difficult of assimilation, it nevertheless remains 
a fact that many of the simplest foods are capable of acting as poisons 
in susceptible persons. A large number of persons cannot take milk 
or eggs because their digestion of these substances is faulty, and the 
writer is cognizant of one case where lobster salad can be eaten at bed- 
time without discomfort, while an egg at breakfast will cause a severe 
headache or pain in the belly. Rules as to diet must not be " iron- 
clad." but based on observation. 

By far the best means of maintaining hepatic activity in cases 
where this organ is torpid is horseback exercise, particularly if the 
exercise is taken on a trotting horse, as the jolting of the liver keeps 
the chain of digestive functions active and prevents the secretions 
from becoming clogged. Along with this exercise massage of the 
hypochondrium and belly-walls is useful, and the movement of stoop- 
ing over, bending from side to side, and bending backward with the 
feet close together, is of value. Coffee is often the cause of bilious- 
ness because of its oil. 

The use of pure, orange-colored, undiluted nitromuriatic acid in 
these eases in the dose of 3 minims (0.15) three times a day in half 
a tumblerful of water is invaluable, and the fluid extract of stillingia 
in the <lose of 20 minims (1.3) is of service, as is also the solid extract 
of euou vnius in the dose of 3 grains (0.15). 5-grain (0.35) doses of ex- 
tract of chirata in pill are also useful in hepatic atony of a mild type. 

R.— Ext. chirata? gr. xl (3.0). 

Podophyllio . . . . • gr. iv.j0.2). 

Euonymin gr. viij (0.5). 

Leptandrin gr. viij (0.5). 

CreoBoti gr. x (0.G5).— M. 

I't. in pil. No. xx. 
S. — One pill every night. 



BLEPHARITIS. 551 

The knowledge of the action of many of the poisonous materials 
formed in the alimentary canal renders it possible for us to relieve the 
patient by other means than those which may be generally resorted to 
when the attack is present. Thus, if the pupils are dilated, the skin 
hot and dry, the eyesight dim, and the pulse rapid, the alkaloid pro- 
ducing these signs of atropine poisoning may be antagonized by opium 
in small dose, or if the pulse be slow and full, the arterial tension 
high, and there is throbbing in the head with frontal headache, the 
alkaloid representing digitalis may be antidoted by the use of aconite. 
If nervousness and irritation are present, the bromides and chloral 
may be used. 

For some unknown reason the use of caffeine in the headaches of 
biliousness nearly always makes them worse, particularly if the head- 
ache is due to over-indulgence in coffee. 

If the face is flushed, a mustard plaster or cup to the nape of the 
neck may be used, and a hot foot-bath is often of service. 

In cases where the bilious attacks are associated with catarrh of 
the stomach, intestines, or bile-ducts, chloride of ammonium, in 5- 
grain (0.3) doses, three times a day, is very useful, as is also the 
protiodide of mercury, when triturated with sugar of milk, in the 
dose of g^ to -^ of a grain (0.001-0.0015) three times a day. Fre- 
quently the use of salol or salophen in 10-grain (0.65) doses, three 
times a day, does much good in these cases, acting as an intestinal 
antiseptic. (See Salol.) 

BLEPHARITIS. 

Blepharitis is divided clinically into an ulcerative and non-ulcera- 
tive variety. The indication of prime importance in the treatment 
of this affection is the removal of the scabs and crusts before the 
application of the local remedies. This may be accomplished by the 
use of alkaline solutions, bicarbonate of sodium or bib orate of sodium 
(8 grains to the ounce [0.6 : 30.0]), or a 5 per cent, solution of chloral, 
as recommended by Gradle. The salves that have met with the great- 
est success are Pagenstecher's ointment (yellow oxide of mercury, 1 
grain [0.05], vaseline 1 drachm [4.0]), dilute citrine ointment, pyro- 
gallic-acid ointment, or a 3 per cent, milk-of-sulphur ointment, to 
which resorcin may be added. The latter application is useful in the 
squamous variety alone. In the ulcerated form, if the crusts are 
tenacious, these, as well as the stunted cilia, must be removed with 
forceps, and yellow-oxide-of-mercury salve or some similar application 
applied. Excellent results follow T touching the crater-like abscesses 
which exist in edges of the lid with nitrate of silver. If there is 
an accompanying conjunctivitis, a boric-acid solution is suitable, 
while under any circumstances obstruction of the lachrymal duct 
— a frequent accompaniment of the disease — must be removed, and 
the nasal passages explored for any chronic inflammatory condi- 
tion. The relation between this disease and the presence of refrac- 
tive errors demands the correction of the later, should these exist, 
before a hope for cure may be entertained. 



552 DISEASES. 



BOILS. 



Boils are dependent upon an impoverished state of the system, or, 
more rarely, on some local trouble situated in the skin, as in the persons 
of oil- or paraffin-workers. 

Their constitutional treatment rests upon the use of fresh air, cod- 
liver oil, iron, arsenic, phosphate of sodium, and, if any boils are 
present at the time, the use of the sulphurate of calcium in the dose 
of -jL- grain (0.006) every five hours. The sulphurate of calcium 
hastens the maturation of boils and prevents the formation of new 
ones, but is useless, according to its original user, Dr. Ringer, in the 
boils which appear during the course of some cases of diabetes. 

The local treatment of boils may be divided into the abortive and 
curative methods. The abortive method consists in painting the 
inflamed spot, when the trouble first begins, with a solution of gun- 
cotton (collodion), and renewing the coat hour after hour until a heavy 
contractile covering is formed. If pus forms under this, it may be 
absorbed, but if this does not occur, then the boil must be opened 
under antiseptic precautions and properly dressed. A strong solution 
of nitrate of silver is also very useful at the very beginning of the 
formation of a boil if painted over the part in the strength of 20 
grains to the ounce (1.3 : 32.0). The other local applications consist 
in the use of the extract of opium or belladonna over the part to 
relieve pain and decrease the inflammation. 

Poultices may also be used to relieve the sensation of tenseness 
and mature the boil, and should contain sweet oil and laudanum. 
Ringer recommends the application of alcohol and camphor over the 
skin in the early stages. After the skin is wiped dry it is to be 
smeared with camphorated oil. Stelwagon uses the following : 

R.— Ichthyol 3J (4.0). 

Emplast. plumbi £ij (8.0). 

Emplast. resinse gij (8.0). — M. 

S. — Apply to the part. 

He also approves of the injection of a few minims of a 5 per cent, 
solution of carbolic acid into the apex of the boil if its formation is 
assured. 

When boils occur in the external ear the canal should be frequently 
irrigated with hot water, and if the boil is mature it is to be incised. 
A useful pain-relieving dressing for the boil is as follows : 

R. — Iodoform gr. iv (0.2). 

Menthol gr. ij (0.1). 

Vaselini gj (4.0).— M. 

S. — Smear on cotton plugs and insert in the ear twice or thrice a day. 

BREASTS (INFLAMED). 

Lactation should at once cease and the milk be removed by the 
aid of massage and the breast-pump. A bandage exercising pressure 
i- imw applied and an ice-bag placed over it. This is only useful in 



BRONCHITIS. 553 

those cases in which the glands are the part affected. When the 
connective tissue is involved lead-water and laudanum should be 
applied, and saline purgatives used. Belladonna ointment may be 
smeared over the breast with advantage in both forms to check 
secretion and allay inflammation. As soon as pus has formed it 
should be set free by an incision in the line of the ducts. If it be 
deeply situated, it should be opened by an incision close to the chest 
and the pockets opened by a grooved director or dressing-forceps and 
packed with gauze. 

In the early stages of the inflammation, if the circulation is bound- 
ing, it should be thoroughly impressed by aconite or veratrum viride. 

BRONCHITIS (ACUTE AND CHRONIC). 

In the early stages of bronchitis there is always present a very 
distinct hypersemia, followed by a true inflammation of the mucous 
membrane lining the bronchial tubes. When these changes are con- 
fined to the larger bronchi, the term " bronchitis " is employed, but 
when the minute bronchioles are invaded, the disease is known as 
"capillary bronchitis." In the article on Pneumonia and elsewhere 
in this book the writer has spoken of the various stages of inflamma- 
tion, the measures indicated under such circumstances, and has de- 
scribed the action of the various drugs. In many cases the phy- 
sician only sees the patient when the second stage of his disease is 
present, but if the individual presents himself at once, the following 
history and physical signs will indicate the treatment to be employed : 
After exposure, more or less severe, to wet, dampness, or dry cold, a 
sensation of oppression comes on, associated with a feeling of " tight- 
ness across the chest " or a sensation as if a bolus of food was under 
the sternum. Aching and pain may then be traced over the lines of 
the bronchial tubes, while the dry, hacking cough increases the dis- 
comfort and seems to strain the tubes till each one can be outlined on 
the chest-wall by the patient. The cough, when it occurs, is vir- 
tually unproductive, and often hurts the larynx and throat. On mak- 
ing a physical examination by auscultation there will be found over 
the posterior aspect of the chest, between the shoulder-blades, sounds 
of bronchial breathing, which are rougher than normal, and due to 
the air passing over an inflamed, swollen, and roughened mucous 
membrane. This bronchial roughening may be sufficient to cause 
a harsh inspiratory sound over the entire chest, and the expiratory 
sounds may be heard a little louder than usual. No other changes 
from the normal can be noted, but isolated spots of discomfort may 
be pointed out by the patient where aches, " catches," or " kinks " 
seem to be present in a previously normal tube. Percussion, palpation, 
and inspection show nothing more of note. Some fever may be present. 

The patient should receive a hot foot-bath, take a glass of hot lem- 
onade with a little whiskey in it, and go to bed at once, in order that 
by inducing a profuse perspiration he may relieve the bronchial con- 
gestion. Often a dose of Dover's powder is useful in hearty adults to 
aid in causing perspiration. In children the chest should be well 



554 DISEASES. 

rubbed with camphor liniment and a little tincture of aconite be given 
in water with sweet spirit of nitre every hour, as follows : 

R — Tinct. aconit Tr^viij (0.6). 

Spt. a?ther. nitros f^ij (8.0). 

A qua destillat q. s. ad f^j (30.0).— M. 

S. — A half teaspoonful (2.0) to a child or a dessertspoonful (8.0) to an adult in water 
every hour. 

In many adults 5 to 10 grains (0.30-0.65) of Dover's powder with a 
hot drink are better. 

If the attack is not aborted while the first stage is still present, 
before secretion is established, resort should be had to ipecac and to 
citrate or acetate of potassium, which act as sedatives to the inflamed 
mucous membranes and aid in the formation of secretion, moistening 
the inflamed surfaces and thereby overcoming the dryness and irrita- 
tion. These potassium salts also act as febrifuges, and should be used 
in full doses, as much as 40 grains to 1 drachm (2.6-4.0) in a day, in 
addition to the aconite already recommended. The following pre- 
scription illustrates their employment : 

R. — Syrupi ipecacuanhas f^j vel f^iij (4. 0-12.0). 

Potassii citratis ... £iv (16.0). 

Aquae destillat q. s. ad f^yj (180.0).— M. 

S. — Dessertspoonful (8.0; every four hours for a child of five years. 

Or, 

R. — Syrupi ipecac f^ij (60.0). 

Succilimonis . fjj (30.0). 

Potassii bicarbonatis ^iv (15.0). 

Spirit, aether, nitrosi f^j (30.0). 

Aquae destillat q. s. ad f^vj (180.0).— M. 

8. — Dessertspoonful (8.0) every four hours for an adult. This mixture should not be 
corked for some time after it is made. 

For a child this prescription should be reduced just one half in 
each part with the exception of the water. 

In some cases, particularly if the patient be a child, large doses of 
the citrate or other salt of potassium exert a depressing influence and 
have to be decreased. 

Counter-irritation may be applied to the chest in the shape of a 
mustard or spice plaster. If the soreness of the bronchial tubes is not 
relieved by this means, inhalations of steam arising from boiling water 
may be practised, either through a cone, one end of which covers the 
top of a pitcher and the other end of which covers the mouth and nose 
of the patient, or by covering the head and pitcher with a towel. 
The usefulness of this method may be much increased by the addition 
of 1 tablespoonful of compound tincture of benzoin to each pint of 
water. 

In young children, particularly in the first stage of bronchitis and 
id the later stages, the use of the so-called ''bronchitis tent" is of 
great value. It consists of a canopy raised over the bed a sufficient 
distance to allow of the circulation of plenty of air. Through one side 
of this canopy passes a tube leading from an Arnold steam sterilizer, 
under which is an alcohol lamp to keep the temperature of the water 
sufficiently high. (Fig. 101.) By this means the air breathed by the 



BRONCHITIS. 



555 



patient is so saturated with moisture that the mucous membrane 
lining the air-passages is soothed and quieted. In order that the full 
benefit of this measure be understood, it must be remembered that a 
mucous membrane in the early stages of inflammation is always dry 
and red, lacking its normal moisture, and that the upper air-passages 
fail to catch upon their surfaces, by reason of their dryness, particles 
of dust, and do not moisten the air before it reaches the lungs. 
Again, it will be remembered that the bronchial mucous membrane is 
covered with ciliated epithelium, which, by the constant, upward, wavy 
motion of its cilia, urges out of the lungs all impurities. Dryness of 
the suiface at once stops this ciliated movement, with unfavorable 
results. The employment of the "bronchitis tent" is equally useful 
in adults, but less readily employed, owing to the size of the bed. 

Fig. 102. 




Bronchitis tent put up by aid of two sheets pinned together and four broomsticks lashed to cor- 
ners of bed. The steam arises from an Arnold steam sterilizer to which has been attached 
a tube. When in operation the side flap of the tent is dropped. 



Having considered the treatment of the first stage of bronchitis, 
we pass to that of the second. The condition of the mucous mem- 
branes is now quite different from that which we have just been 
speaking of. In the place of an absolute lack of secretion we have 
a profusion of cast-off epithelial cells, a large amount of mucus, and 
more or less liquid poured out upon the walls of the bronchial tubes, 
forming obstructions everywhere to the ready passage of air. The 
secretion is apt to be more or less viscid, ropy, and, when it is coughed 
up after considerable effort, appears in lumps, particularly in the 



556 DISEASES. 

morning. This state is one in which the excitement of inflammation 
is followed by local depression and an effort on the part of the tissues 
to rid themselves of the congestion and of the useless epithelial forma- 
tions. The physical signs on listening to the chest are now found to 
consist in a large number of loose rales which are distinctly wet and 
moist. Later they become markedly liquid and bubbling, and so large 
as to cause gurgling on inspiration and expiration. Sometimes they 
are musical or squeaking. Generally the latter signs do not come 
on until the case is far advanced, and, if a cure is soon to be reached, 
they only last a few days or hours, as the mucus is so loose as to be 
easily coughed up and the lung readily cleared. 

The object of the physician is to use remedies which will stim- 
ulate the bronchial tubes and increase the volume of liquid poured 
out. For this purpose the bronchitis tent may of course be employed, 
but the drugs to be used internally are ammonium, chiefly the chlo- 
ride, and the pitches and turpentines, such as terebene, pyridine, 1 or 
even turpentine itself. 

In the majority of instances an ammonium mixture will be the 
best and most serviceable prescription, in one of the following forms : 

R . — Amraonii chloridi gij (8.0). 

Ext. glycyrrhiz. fluid f^ij (8.0). 

Aqua? destillat q. s. ad f^iij (90.0).— M. 

S. — Teaspoonful (4.0) everv four hours. 
Or, 

R. — Ammonii chloridi ^ij (8.0). 

Mist, glycyrrhiz. comp f^iij (90.0). — M. 

S. — The same dose. 

The disadvantage of the latter prescription is the presence of anti- 
mony in the compound liquorice mixture, w r hich is contraindicated if 
debility exists. 

If the cough is troublesome, a little morphine or belladonna may 
be added, or the following be used, particularly if any signs of car- 
diac failure appear : 

R. — Ammonii chloridi ... gj (4.0). 

Ammonii carbonatis 3j (4.0). 

Ammonii bromidi • • 3J (4.0). 

Extract, glycyrrhiz. fluid f^iv (16.0). 

Aquae destillat f^vj (180.0).— M. 

S.— Dessertspoonful (8.0) every four hours. 

In this prescription the first constituent acts particularly on the 
air-passages, the second stimulates the heart and respiration, and the 
third allays the cough, while the liquorice covers the salty taste of the 
ammonium. Still another recipe is : 

R. — Codeinse sulpfaatis gr. ij vel iv (0.1-0.2). 

Amnion chlorid ^j (4.0). 

Ext. glycyrrhiz. fl f,|j (30.0). 

Aquae destillat q. s. ad fgij (60.0).— M. 

S. — Teaspoonfu] (4.0) every two hours in water. 

1 Pyridine, not pyrodine, is used by placing 1 fluidrachm (4.0) on a hot shovel or 
saucepan in a small room, the patient breathing the fumes, which are carried to him 
by the air of the apartment. 



BRONCHITIS. 557 

An oro-nasal respirator, with the sponge saturated with equal 
parts of terebene, iodide of ethyl, and chloroform, may be worn in 
order to allay cough and loosen the mucus. 

If the administration of the chloride of ammonium does not aid in 
the expulsion and liquefaction of the secretion and rid the lungs rap- 
idly of the mucus, the use of terebene in 5- or 10-minim (0.35-0.65) 
capsules may be resorted to with great success. If capsules cannot be 
supplied, terebene may be made into an emulsion with acacia or trag- 
acanth and given in this way. Sometimes terebene will irritate the 
kidneys and produce a sense of weight across the loins ; if this occurs, 
its use should be stopped. In other cases it will disorder the stomach 
or cause diarrhoea. These effects are not, however, commonly seen. 
Terpine hydrate in 10-grain (0.65) doses may be used three times a 
day, or terpinol in the dose of 8 to 10 grains (0.5-0.65) in capsules 
or pills. Certain of the volatile oils and resins are also of value at this 
time, notably the oleoresin of cubebs and copaiba, which, however, 
possess the disadvantage of disordering the stomach. The oil of 
eucalyptus is also of great value, and may be given in capsule or 
emulsion in the dose of from 1 to 5 minims (0.05-0.35) every five 
hours. The oil of sandalwood in the dose of 5 to 10 minims (0.35- 
0.65) is very valuable, and is not so apt to disorder the stomach, 
bowels, and kidneys as are some of the other remedies named. Some- 
times the use of a nebulizer, as shown on page 490, is very useful, or 
Yeo's inhaler may be used. (See Creosote, Part II., and Inhalations, 
Part III.) 

While the proper use of these remedies usually brings about the 
results desired, in others a stage of profuse secretion comes on which 
in its treatment is identical with that seen in chronic bronchitis, 
chronic "winter cough," and emphysema, so these diseases will 
therefore be considered together. 

In old persons suffering from dilated bronchial tubes, from emphy- 
sema, and from chronic bronchitis there is constantly poured into the 
air-passages so free a secretion that persistent coughing is necessary to 
rid the lung of enough of the mucus and liquid to enable the man to 
breathe. Any excess of this exudation drowns him in his own secre- 
tions, and the constant obstruction to the ready flow of air and blood 
in the lung soon produces dilatation and weakness of the right side 
of the heart. The same condition in a more acute form sometimes 
asserts itself in young children and in adults. In children it some- 
times comes on so suddenly as to be known as " acute suffocative 
catarrh," while in older persons it appears with sufficient severity to 
make the condition of the patient most serious. Of the treatment of 
the latter state the writer will speak at once. 

The objects desired are to rid the lung of the liquid secretions, to 
prevent the outpouring of more exudations, and to support the patient 
until the crisis is past. Where the exudations rapidly fill the lung, 
nothing is better in the strong child or adult than an active emetic, 
such as apomorphine, hypodermically, in the dose of y 1 -^ grain (0.006) 
to an adult or -^ to a child, which is not to be repeated ; if this dose 
fails to act in ten minutes, ipecac may be used instead in the form of 



558 DISEASES. 

the powder, a small teaspoonful for a man or 5 to 10 grains (0.35- 
0.65) for a child, or, if the powder be not at hand, a wineglassful (30.0) 
of the wine or syrup of ipecac to an adult or two teaspoonfuls (8.0) to a 
child may be given. Digitalis should be administered to support the 
heart, and strychnine be employed in full dose to stimulate the respira- 
tory centre and excite the nervous system, which is generally depressed 
by the increasing carbonic acid in the blood. For the same purpose 
caffeine or strong coffee may be used. Oxygen may be inhaled, and 
to stop the profuse secretion atropine may be used by the mouth or hypo- 
dermically. If death seems at hand, hot and cold dashes of water may 
revive the patient sufficiently to keep up respiration until voluntarv 
efforts are made by the patient. Sometimes letting the patient hang 
his head over the side of the bed when he coughs may aid in the ex- 
pulsion of the liquid. 

The treatment of the more moderate condition of excessive secre- 
tion in the bronchitis of old persons, which is more slow in its prog- 
ress, but which may end as fatally as similar attacks in the young, 
is somewhat similar to that just given. Injurious results are often 
produced by the physician failing to recognize that the secretion is suf- 
ficiently liquid, and that ammonium and such expectorants are not 
only useless, but harmful, because they increase the quantity of these 
liquids. Under these circumstances the application of several dry 
cups over the bases of the lungs posteriorly often gives a great deal 
of relief; or if cups cannot be obtained, then active counterirritation 
by means of a mustard-plaster or turpentine stupe is advisable. 
The cups are, however, the remedy of choice. Belladonna, which 
checks secretion, stimulates the respiratory centre, and is for this 
reason a doubly useful remedy. Strychnine is, however, the best 
of remedies to help the patient get rid of the sputum. It should 
be given in the dose of -^ grain (0.006) or more three times a day. 
When the condition is pressing we should use atropine and strychnine 
hypodermically. 

The use of remedies designed to allay the cough in these cases is 
absolutely unjustifiable, as it results in the retention of the profuse 
secretion. The question as to whether the cough is excessive or not 
must depend on the ability of the lung to rid itself of the secretions 
in its bronchial tubes. 



BURNS AND SCALDS. 

The treatment of burns and scalds is both internal and external, 
the first being devoted to the quieting of the nervous system after the 
injury, the relief of pain, and the treatment of shock ; and the second 
to the care of the injured surfaces. Immediately upon being called 
to a severe case of burn it is the duty of the physician to determine 
how badly shocked the patient is, what the condition of the pulse may 
be, and whether or not the lungs and air-passages are involved. After 
these mental notes lie should give a hypodermic injection of ^ to J- 
grain (0.016-0.03) of morphine and T -J^ of atropine (0.0006), and 



BURNS AND SCALDS. 559 

then roll the entire body in a large quilt to maintain the bodily heat 
while the sufferer is being transferred to the hospital or the house to 
which he belongs. 

In some cases the shock is so great that the pulse flags at once, the 
temperature falls, and collapse ensues. Stimulants hypodermically, 
external heat, and drinks of hot water and whiskey are indicated, 
followed by -^ grain (0.003) of strychnine and 5 minims (0.3) of 
tincture of digitalis if the circulation does not respond to the less 
powerful stimulants. 

A very useful treatment under these circumstances is to immerse 
the patient in a bath of warm water, hot enough to maintain the 
bodily temperature. Often while in this bath the burned cuticle is 
easily removed with but little pain, and the protection from the air 
decreases dermal irritation. 

If time and circumstances permit, the dressings should be applied 
before moving the patient, but this is rarely possible. By far the 
best dressing is lint wrung out of a mixture of picric acid. (See 
Picric Acid, Part II.) Another useful application is linseed oil and 
lime-water, equal parts, or, if desired, the oil may be rendered anti- 
septic by the addition thereto of 1 part of carbolic acid to 20 parts 
of oil. This mixture is also of service in that it acts as a feeble local 
anaesthetic. The cloths should be renewed every twelve or twenty- 
four hours, as may be needed, or they may be substituted by lint 
wrung out of a saturated watery solution of boric acid. A useful 
application for severe burns is a dusting powder composed of: 

S. — Dust the injured surface with this powder and dress it with dry gauze. 

Still another good application is that of the late Professor Rice, 
which is very efficacious as an application to burns, being better than 
carron oil or any of the preparations ordinarily used. It is as follows : 

R.— White gelatin .^viiss (225.0). 

Glycerin f£j (30.0). 

Carbolic acid f£j (4.0). 

Water f^xvj (480.0). 

Soak the glue in the cold water until it is soft ; then heat it on a water-bath until it 
is melted. Add the glycerin and continue heating until a firm, glossy skin 
begins to form on the surface of the mixture, in the intervals of stirring. Now 
add the carbolic acid and mix intimately. 

This mixture may be kept ready prepared, and is best preserved 
in well-closed glass or porcelain jars. When it is wanted for use, it is 
heated on a water-bath until just melted and applied with a soft, flat 
brush over the burned part, where it will form a strong, flexible skin. 

If the burn is not very diffuse, a solution of the tincture of can- 
tharides, 1 part to 40, upon a rag, is said to relieve pain and aid in 
healing, but if the burned surface be extensive this treatment cannot 
be resorted to, owing to possible irritation of the kidneys, which are 
already overtaxed by the interference with the functions of the skin. 



560 DISEASES. 

In comparatively small burns a saturated solution of carbonate of 
sodium (washing soda) often does great good in relieving the pain. This 
relief may depend on the solvent power of this salt over albuminous 
deposits, formed by the heat, which irritate the peripheral nerves. 
Sometimes the addition of antipyrin to this solution is of advantage, 
and the following may be used for superficial and limited burns : 

U .—Acid, boric giij (12.0). 

Antipyrin giss (6.0). 

Aqure purificat f ^viij (250 cc). — M. 

A very important point in the subsequent treatment of burns is 
the remembrance of the close relationship existing between the internal 
organs, particularly the duodenum and the kidneys, and the cuticle. 
When we recollect that we try to influence internal congestions — such 
as pulmonary congestion — for example — by the application of irrita- 
tion to the skin of the chest, we see at once that a widespread and 
severe burn is practically a huge counter-irritant and must reflexly 
affect the viscera. 

Again, the skin, being prevented from exhaling impurities, forces 
the kidneys to do the work, and if the kidneys fail under the strain 
death results. Whenever the Urine is high-colored and cloudy the 
citrate of potassium should be freely given, 20 grains (1.3) in water 
three times a day, combined with 30 minims (2.0) of sweet spirit of 
nitre, care being taken that the depressant effect of the potassium is 
counterbalanced by stimulants. 

In dressing very severe burns the use of a general anaesthetic such 
a« chloroform is proper, but it must be used with great caution. 



CHANCROID. 

The chancroid is a contagious ulcer which has no definite period of 
incubation, is distinctly inflammatory in type, and is usually multiple. 
It is further distinguished from the primary sore of syphilis by the fact 
that it is auto-inoculable, is not followed by secondary eruptions, and, if 
it involves the lymphatics at all, produces an acute inflammatory swell- 
ing which frequently attains a considerable size and suppurates. 

Chancroid, being a purely local affection, would seem to require 
nothing beyond local treatment : this is true of the uncomplicated sore, 
but where phagedena or serpiginous ulceration sets in the question of 
constitutional treatment is of paramount importance. 

The treatment of uncomplicated chancroid is in its early stage as 
simple as it is efficient. One thorough cauterization converts the sore 
into a healthy ulcer, the cicatrization of which is quickly and surely 
accomplished. 

As the most efficient means of thoroughly destroying chancroidal 
ulcerations the actual cautery is chiefly commended. This is, how- 
ever, objectionable to patients. Sulphuric or nitric acid will be found 
equally serviceable. The pain of these applications may be greatly 
lessened by the previous employment of a 20 per cent, solution of 



CHANCROID. 561 

cocaine. When the surface involved is large the patient should be 
etherized. The cardinal point in the cauterization of chancoids is to 
reach and destroy all the diseased area. Each pocket and sinus must 
be thoroughly acted upon, otherwise it remains as a focus for reinfec- 
tion. A convenient way of both destroying the chancroid and pro- 
viding for the after-dressing is offered in the application of Ricord's 
paste. This is made by adding to finely powdered charcoal enough 
strong sulphuric acid to form a paste of about the consistency of 
castor oil. This is then applied to every portion of the ulcer. The 
acid shortly dries out, leaving a dressing of charcoal, which in a few 
days drops off, exposing a healthy, nearly healed, granulated surface. 
Where nitric acid is applied the subsequent dressing consists, pre- 
ferably, in the application of dusting powders, iodoform being the 
best. 

There has been a tendency of late years to substitute for this treat- 
ment one less radical, more acceptable to the patient, and in many 
cases almost equally satisfactory in results. It is certainly true that 
many of the chancroids as found in persons of robust health show 
little tendency to spread beyond comparatively narrow limits, and are 
amenable to mild treatment. It must be remembered, however, that, 
as long as the smallest portion of such an ulcer remains unhealed it 
may at any time take on all the features of a virulent ulceration. 
Moreover, the patient is constantly exposed to the risks of a chan- 
croidal bubo — a complication so troublesome that the possibility of 
its development constitutes the strongest argument against palliative 
treatment. 

Where the ulceration is entirely superficial, constituting the erosive 
form of chancroid, iodoform, dusted over the surface of the carefully 
cleansed granulations, offers the best form of palliative treatment. 
As a cleansing and stimulating wash to precede the application of the 
iodoform 1 drachm (4.0) of nitric acid to the pint (500 cc.) of water 
is most satisfactory. The objection to iodoform lies in its disagree- 
able and penetrating odor. To prevent this, great care should be 
exercised in applying the pow^der to see that none is distributed else- 
where than upon the sore. The odor can also be disguised to some 
extent by thoroughly mixing with the iodoform a small quantity of 
one of the essential oils, such as oil of peppermint or attar of roses, 
using not over 5 minims (0.35) to 1 drachm (4.0) of the powder. 
There is no dusting powder which can entirely take the place of 
iodoform, yet when the objections to the use of the latter are insu- 
perable aristol or iodol may be substituted, or a mixture of 1 drachm 
(4.0) of zinc oxide and 3 drachms (12.0) of subnitrate of bismuth, or 
equal parts of calomel and bismuth. Where the discharge is profuse, 
powdered tannin may be combined with the dusting pow r der in the 
proportion of 1 part to 4. 

In the ordinary uncomplicated chancroid these dry dressings are 
greatly to be preferred to wet applications : when, however, the sore 
is attacked by a high grade of inflammation and becomes indurated, 
prolonged immersion of the part involved or of the whole body in hot 
water may be followed by the application of dressings kept constantly 



562 DISEASES. 

wet with the dilute nitric-acid lotion, as given above, or with weak 
carbolic solution, 5 grains to the ounce (0.35 : 30.0) of water, or with 
lead-water and laudanum. Where the chancroid assumes the phagedenic 
type, extending with great rapidity and causing extensive sloughing 
and destruction of tissue, free cauterization either with the hot iron 
or by means of nitric acid should be instituted immediately, every 
portion of the ulcerating surface being thoroughly destroyed. This 
should be followed by prolonged hot sitz-baths or general warm baths, 
the patient remaining in the water for days at a time if necessary, 
and, if practicable, eating and sleeping with the body still immersed. 
If this is not possible, baths of from two to four hours' duration 
should be given two or three times daily. After cauterization, pow- 
dered iodoform is the best local application in phagedenic cases. In 
addition the patient may be given full doses of opium, and should 
receive a tonic and supporting treatment. 

Should the chancroid assume the serpiginous type, slowly extend- 
ing in spite of treatment, till in the course of months or years large 
areas are destroyed by the process, the warm bath, continued night 
and day for weeks at a time, together with thorough cauterization of 
the entire diseased surface with the hot iron, represents the most 
satisfactory method of treatment. In all such cases a thorough trial 
should be given to the treatment appropriate to tertiary syphilis. 

The chancroidal bubo is best avoided by prompt and thorough 
cauterization of the sore : when it occurs, however, it should be first 
treated by rest, pressure, and counter-irritation, since it may be a 
simple inflammatory adenitis, and with care may not run on to sup- 
puration. Iodine may be painted around the swollen area, the patient 
should be put to bed, and a compress should be applied wet with dilute 
lead-water and alcohol, and held in place by a spica bandage of the 
groin, or this may be substituted by a hot bag placed upon the inflamed 
gland. At the first sign of suppuration the bubo should be punctured 
by a tenotome, evacuated, and washed out with a bichloride solution 
(1 : 1000), and dressed antiseptically. If there be a reaccumulation of 
pus, the puncture and washing should be repeated. If inflammatory 
symptoms still persist, the diseased gland should be thoroughly re- 
moved by dissection or the curette through a free opening, the result- 
ing wound being drained by gauze and sutured. If the bubo takes on 
phagedenic action, it should be treated as the phagedenic chancroid. 

CHOLERA, ASIATIC. 

The treatment of this exceedingly dangerous disease is prophy- 
lactic, curative, and convalescent. 

The first measures consist of strict quarantine, both public and 
private, the avoidance of all water for culinary purposes which has 
do! been boiled at least an hour and cooled in a place devoid of 
germs, and the employment of those foods which, while preserving 
the normal bodily health, in no way predispose to intestinal dis- 
turbances, as do some of the fruits, as melons and grapes. If these 
things are attended to, little remains to be done; but it is worthy of 



CHOLERA, ASIATIC. 563 

remark that sulphuric acid is a drug which is harmless in itself, yet 
apparently one which is possessed of distinct prophylactic power in 
this disease. 

Dividing the disease into three stages, we find as the earliest symp- 
tom some disturbance of peristaltic movement, with or without pain, 
or in other instances the patient is attacked with a sudden" flux of the 
intestinal contents. If there is a history of the ingestion of bad or 
indigestible food, there is no doubt whatever that this foreign material 
must be gotten rid of by the use of castor oil or sulphate of magnesium, 
the latter being the best, because it is more rapid and less apt to 
cause griping. No purgative should be given unless the history of 
the ingestion of bad food is most direct and clear. 

When the attack is sudden in its onset, as is usual, the question 
arises, Shall we resort to opium by the mouth ? The answer, after 
having carefully considered the statements of a large number of 
authors, is that we should not use opium by the mouth or hypo- 
dermically except in cases where the pain or cramps are so excessive 
as to absolutely require the drug. In other words, it is to be given 
for the pain, not for the diarrhoea. Should opium be used, it is 
infinitely better to employ it by the rectum in the manner to be 
described later, and if it is necessary to use it by the mouth, only 
the deodorized opium or the deodorized laudanum should be em- 
ployed, since these preparations are less apt to cause nausea than 
their fellows. 

Camphor, on the other hand, seems to be universally regarded as 
a most useful drug, tending at once to stop diarrhoea and relieve the 
pain and cramps from the beginning to the end of the attack. Whether 
camphor exercises any germicidal effect on the cholera bacillus we do 
not know, pertain it is that volatile oils all possess distinct antiseptic 
powers. Aside from any such influence, camphor is useful as a general 
systemic stimulant, and has been proved by wide clinical observation 
to have a very extraordinary power in the control of all forms of 
serous diarrhoea, particularly true cholera. The spirit of camphor has 
proved most effective in cholera epidemics. Frequently the use of 
camphor so controlled the diarrhoea and stimulated the torpid kidneys 
that anuria was set aside in twenty-four hours. Under these conditions 
camphor wine has been found to be very useful ; it is to be made by 
adding 75 grains of finely-powdered camphor to a quart bottle of strong 
red wine, to which is also added gum arabic and alcohol. The camphor 
is first dissolved in the alcohol, and then thoroughly mixed with the 
wine. The dose of this mixture is a teaspoonful, in peppermint tea, 
every hour to a child of six years, for an older child a dessertspoonful, 
and for an adult a wineglassful. Those who first used this mixture 
were wiser than they thought, for the recent studies of Pick have 
shown that both red and white wine are distinctly inhibitory to the 
growth of the spirillum of cholera, probably because of the tannic or 
other acid which they contain, as well as the alcohol. 

A remedy, the use of which is based on very rational grounds, is 
salol, and probably the newer drug salophen, which, theoretically, is 
much better than the former, because it is less poisonous. According 



564 DISEASES. 

to the interesting studies of Lowenthal, salol seems to be peculiarly 
antagonistic to the bacillus of cholera. This investigator added to a 
50-grainme alkaline solution of pancreatic juice 10 grammes of salol, 
and to this mixture 3 centimetres of a good bouillon culture of the 
bacillus. Examinations in from forty-eight hours to a week showed 
this to be absolutely sterile. It was further proved that the salol was 
inactive until broken up into its component parts — phenol and sali- 
cylic acid. Hueppe also asserts that the use of salol prevents the 
development of anuria. 

The use of a remedy originally proposed by Dr. R. G. Curtin has 
been proved bv recent study to be eminently rational. This remedy 
is sulphuric acid. This drug not only is acid, and so deleterious to 
the bacillus, but, in addition, is astringent, and is probably elimi- 
nated as a sulphate by the lower bowel. As is well known, ordinary 
cholera morbus yields readily to its influence. 

In addition to the treatment already given, which may be used in 
the second as well as in the first stages, we have measures which must 
be resorted to for the relief of the dominant symptoms which mani- 
fest themselves as the disease progresses. 

The symptoms now to be combated are vomiting, excessive purg- 
ing, cramps in the extremities, and, as the result of these, exhaustion, 
collapse, and the advent of the algid stage. By far the best results 
obtained by any one line of therapeutics at this time certainly fol- 
lows the employment of salol and camphor by the mouth, with entero- 
clysis and the use of hot baths ; or, if these are not possible, hypo- 
dermoclysis and the employment of a hot-water bed ; or, finally, hot 
bottles and bricks, for the patient largely dies of cold and of internal 
congestion of thickened blood, the circulation of which the heart and 
vasomotor system are unable to control. Atropine and strychnine 
are very useful, but ether is better than either, given subcutaneously 
or by the mouth, as a diffusible stimulant. 

Very extraordinary results are said by Italian observers to follow 
the rectal injection of a solution of common salt in the proportion of 
1 drachm to the pint (4.0 : 500 cc.) of warm water. In other 
instances the use of tannic acid in the strength of from 1 to 8 
drachms to the pint (4.0-30.0 : 500 cc.) of water has proved very 
satisfactory. The amount used at each injection should be about 2 
quarts (2 litres) and the injection made as gently as possible in order 
to urge the fluid high into the bowel. The inflow tube should be a 
soft female catheter, and the overflow tube twice as large as the inflow 
tube. The tubes are to be inserted side by side after thorough oil- 
ing. The injection may be used every two hours and continued till 
the outflow is clear. This is done to wash out poisonous materials 
and to supply liquid to the system. A solution much stronger or 
weaker than that named is dangerous, for similar reasons to those 
given under the head of Dropsy and Saline Purgatives. (See, also, 
EnteroclysiSj Part III.) 

Another useful measure is hypodermoclysis, or the passage of a 
solution similar to (hat just named into the subcutaneous tissues of 
the thigh or belly-wall. (See Hypodermoclysis, Part III.) If done 



CHOLERA INFANTUM. 565 

slowly these injections are absorbed readily and supply liquid to the 
depleted blood-vessels. (See article on Diarrhoea.) 

CHOLERA INFANTUM. 

Cholera Infantum is a term often applied to all the forms of active 
serous diarrhoea afflicting children in the summer months, whether its 
cause be exposure to high heat, the use of bad food, or both. The 
treatment by the use of drugs is identical in all forms of serous diar- 
rhoea in children as. far as the purging is concerned, but the cause 
requires great care in its discovery and skill in its removal if that be 
possible. 

In cities, where the heat is often great, the air damp and impure, 
and the food not always fresh, cholera infantum often appears as a 
form of thermic fever or heat-exhaustion, or, in other words, as sun- 
stroke. Often in these cases the temperature in the rectum will be 
found febrile, while that of the axilla is below normal, and, as pyrexia 
does harm to the internal organs, the internal temperature must be 
lowered by cool drinks, by administering pieces of ice, and the irriga- 
tion of the bowel, which will be described in a moment. The diarrhoea in 
such cases is dependent upon a relaxation of the blood-vessel walls in the 
intestine by reason of the influence of the high heat upon the splanch- 
nic nerves, and to irritant matters derived from food and resulting from 
defective secretion of the digestive juices. If the thermometer placed 
high up in the rectum shows a subnormal temperature, heat-exhaustion 
is present, not thermic fever, and the treatment is reversed. Hot 
drinks are to be used, external heat applied, and friction of the limbs 
resorted to, or the child may be put in a hot bath at a temperature of 
105° F., its temperature being carefully watched lest it rise suddenly 
to a point above the normal. Avoidance of milk and the use of a few 
drops of beef-juice in water for twenty-four hours is the best order as 
to diet. If vomiting is active and collapse is threatened, a drop or 
two of good brandy should be used in each teaspoonful of food, and 
the value of atropine as a vasomotor stimulant is not to be forgotten. 

There is another form of cholera infantum which is not due to a 
high atmospheric temperature alone, but more commonly to the inges- 
tion of irritant foods or foods unsuited to a child, obtained by the 
patient surreptitiously or through the ignorance of the parents. If 
there is such a history and the probable cause is discovered by reason 
of some of the masses of undigested food having been passed, a purga- 
tive dose of castor oil (1 to 2 teaspoonfuls [4.0-8.0] to a child of two 
years), with 20 minims (1.3) of paregoric, should be used to sweep 
out the offending materials and allay irritation, and be followed at 
once by the treatment which will be spoken of in a moment. Care, 
of course, should be taken to maintain the bodily heat, or lower it if 
it is much above the normal, and a watch must be kept upon the pulse 
and breathing to note any changes requiring stimulants. 

There is still another class of cases. The physician will be 
called to see a child with the same history of having taken indiges- 
tible food or of there being curds in the stools, Careful examination 



666 DISEASES. 

will show that there is much bearing down, or in other cases a simple 
running off of the liquid from the bowel almost without effort. Very 
soon, indeed, the passages become entirely colorless, except for a speck 
or two of green, which shows the presence of the peculiar micro- 
organism which produces this color. The diapers have a peculiar 
mousy odor, and are characteristic ; that is, they seem to be only 
wet and odoriferous, and contain no solid matter. If closely exam- 
ined, they will be seen to be soiled by a small amount of a whitish 
substance, looking like a paste made of water and fine chalk. Such 
a passage bodes ill for the child unless treatment is instituted. The 
physician should order, at once, -fa grain (0.003) of podophyllin for a 
child of six months, to be taken in two doses, half an hour apart, in 
20 drops of brandy with a little water. Two hours after this the dose 
should be repeated, and again in two hours more if necessary. By 
the end of the fourth hour there will be generally seen in the move- 
ments of the bowels a trace of color, and this will gradually become 
more marked if the case is to have a favorable termination. 

As soon as the movements have changed from the pasty-white 
motions named to those having a bilious color, then, and not till then, 
are astringents to be employed. If they are used before this, the 
diarrhoea may become less for a few hours, but the child absorbs 
poisons from its alimentary canal and rapidly goes into collapse. 

The rationale of this treatment rests upon the fact that owing to the 
disease every gland connected with the alimentary canal has become 
inactive. It is absolutely necessary to bring about glandular activity, 
and podoph} T llin, in the experience of the author, is the best remedy for 
this purpose. During the period that the podophyllin is acting it is well 
to apply a spice plaster to the belly or to immerse the child for short 
intervals in a hot bath to preserve its bodily temperature. 

In practically every case of cholera infantum it is of the utmost 
importance to stop milk-feeding absolutely for a few days. Nothing 
in the way of food may be given, except Valentine's Beef Juice, 
10 minims (0.65) every two hours with a little cold water, or beef- 
juice expressed from rare rump steak, until curds and undigested 
food are no longer found in the stools. 

After these measures have been resorted to, and the chief object — 
namely, a colored stool, not green — obtained, if the diarrhoea continues 
it must be stopped gradually. The medicinal treatment should consist 
in the use of a mixture such as the following for a child of a year or 
eighteen months : 

R.— Acid, sulph. aromat gtt. xxx (2.0). 

Tr. opii camphorat f^ijj (12.0). 

Elixir, curacoje f.^ij (8.0). 

Aqtiffl cinnamomi ...... . q. s. ad fgiij (90.0). — M. 

S. — Teaspoonful (4.0) in a little water every two hours. 

R — Acid, sulph. aromat gtt. xxx (2.0). 

OL caryophylli n\,viij (0.5). 

Tr. opii camphorat f^j (4-0).^ 

Spirit, chloroform] gtt. xlviij (3.0). 

Syr. zingiberia q. s. ad fgiij (90.0).— M. 

-Teaspoonful (4.0) every two hours. 



Or, 



CHOLERA INFANTUM. 567 

If preferred, the tincture of kino or compound tincture of catechu 
may be substituted for the oil of cloves or the spirit of chloroform, 
or, again, the fluid extract of haematoxvlon may be taken in the place 
of either of these. 

Where the vomiting is very severe and incessant, the purging pro- 
fuse, but free from undigested curds, a rectal injection of starch-water, 
2 ounces (60.0), containing 10 drops (0.65) of laudanum, is to be em- 
ployed, and at the same time |- of a grain (0.01) of gray powder 
(hydrargyrum cum creta) given every hour if the podophyllin is not 
well retained. The gray powder may in turn be substituted by -^ 
of a grain (0.005) doses of calomel. Very minute doses of arsenic 
given by means of the following solution are often of service in check- 
ing the vomiting and purging, and should be resorted to if necessary : 

R. — Liq. potassii arsenitis gtt. j vel ij (0.1). 

Aquae cinnamonii f^i (30.0). — M. 

S. — Teaspoonful (4.0) every fifteen minutes until four teaspoonfuls (16.0) are taken. 

In some cases the remedies named above only stop the diarrhoea for 
the time being, and it returns as soon as they are withdrawn. In such a 
case the following is of value to restore the lost tone of the parts involved: 

R.— Resin* podophylli gr. | (0.03). 

Liq. potass, arsenit gtt. iij vel vj (0.18). 

Liquor calcis 15 iij (90.0). — M. 

S. — Teaspoonful (4.0) every five hours. Shake well Wore using. 

Or a powder may be used : 

R.—KesinEe podophylli gr. \ (0.016). 

Pulv. ipecac gr. j (0.06). 

Sacchar. lact gr. xx (1.3). — M. 

Ft. in chart. No. x. 
S. — One powder every five hours. 

A very important, never-to-be-forgotten measure in cholera infan- 
tum is the use of counter-irritation over the belly by means of a 
mustard plaster (1 part of mustard flour to 4 of wheat flour) or by 
a spice plaster. The plaster should be renewed as often as it cools, 
and kept on continuously if the skin will stand it. (See Counter- 
irritation.) 

A remedial measure carried out with great success in cities in the 
treatment of cholera infantum is the use of irrigation of the bowels, 
or rather washing out of the colon. This is accomplished by the use 
of the solution named in the articles on Cholera and Enteroclysis. 
The inflow tube should be of soft rubber, like a female catheter. The 
outflow tube should be larger, in order to carry off flakes of food or 
mucus. They may be inserted side by side after being oiled. The 
pressure used should be by a fountain-syringe raised not more than 
three feet above the buttocks, a»d the outflow should be clear and 
unobstructed. The irrigation may be resorted to every hour or two, 
and continued until clear fluid flows away. The solution should, 
of course, not be too cold nor too hot — say 100° F. (See article on 
Diarrhoea.) 



568 DISEASES. 

CHOLERA MORBUS. 

This acute, painful, rapidly exhausting disease arises from expos- 
ure to cold, the ingestion of poisonous or irritating foods, exposure 
to excessive heat, and a number of similar causes. 

In reality, it may be regarded in one instance as a gastroenter- 
itis, and in another as an acute serous diarrhoea associated with much 
pain of a griping, rending character. Nothing compares to counter- 
irritation for the purpose of affording relief. A large mustard or 
capsicum draft should be placed over the abdomen and allowed to 
remain as long as it can be borne. If the patient knows that he has 
taken irritant foods, J an ounce (15.0) of castor oil with 15 to 20 
minims (1.0—1.3) of laudanum added to it, to prevent griping, should 
be employed to sweep out the offending masses before any other 
remedies are used, and be followed by an antidiarrhcea mixture, such 
as here follows : 

R.— Acid, sulph. aromat f^ij vel f^iv (8.0-16.0). 

Extract, hsematoxylon fluid. . . . .^ij (8.0). 

Spt. chloroformi 13 ss (16.0). 

Syr. zingiberis q. s. ad f^iij (90.0). — M. 

S. — Teaspoonful (4.0) every two hours. 

If the pain is very severe, the patient should be given morphine (gr. 1) 
and atropine (gr. -^q) hypodermically. (See article on Diarrhoea and 
Cholera Asiatica.) 

CHLOROSIS. 
(See Anemia.) 

CHOREA. 

St. Vitus's Dance is a nervous affection, generally occurring in 
children, yielding to treatment quite readily in some cases, and in 
others remaining persistently severe, and even becoming worse, under 
the physician's care. 

The disease is always to be treated by the removal of all sources 
of reflex irritation, such as worms, a long prepuce if it is irritated by 
retained urine or smegma, or other trouble of this character, and in the 
avoidance of punishment or severe rebuke on the part of the attend- 
ants. This advice is given not because chorea is produced by such irri- 
tating conditions, but because they tend to impair the nervous tone of the 
patient. Except in that form of the disease closely associated with or 
dependent upon rheumatism, the profession universally employ arsenic 
in one of its forms as a specific remedy. Generally Fowler's solution 
is used, and, unless the parents are intelligent enough to drop medicine 
carefully from a bottle or dropper,* the physician should order a 3- 
ounce mixture (1)0.0) with 48 minims (3.1) of Fowler's solution, so that 
each teaspoonful will contain 2 minims of the drug. Very frequently, 
to be effective, arsenic must be used in ascending doses, increased 1 
minim (0.05) a day, and in consequence the dilution just spoken of 



COLIC, HEPATIC. 569 

has to be avoided and the importance of care in measuring the pure 
drug impressed upon the patient's relatives. 

Whenever arsenic is used the physician should instruct the attend- 
ants to stop administering the drug if any puffiness under the eyes is 
seen in the morning on arising from bed, or if any pain in the bowels 
ensues, as these symptoms show that the full medicinal action of the 
drug is being felt. 

When arsenic fails, cimicifuga in the dose of 20 to 30 minims 
(1.3-2.0) of a fresh fluid extract for a child of ten years may be used 
as the next best remedy. 

Where the disease is associated with rheumatism, near or remote, 
the salicylates or iodides may be of value, and should be thoroughly 
tried. 

In some cases of chorea the muscular jerkings are so severe that 
sleep is impossible, and the patient has to be held in bed and the bed- 
covers tied down. These cases will often obtain a quiet night by the 
use of the hot pack at bed-time. (See Heat.) The child should be 
placed in a blanket previously dipped in water as hot as can be borne 
by the patient and thoroughly wrapped up in another (dry) blanket to 
retain the heat, and then be allowed to sweat. Care must be taken 
that a heat-stroke does not result, and, if sweating does not come on 
and oppression ensues, the blanket must be removed. The sheets 
should be ironed to have them warmed for the patient when he is 
returned to bed, and it is often better to let him sleep between dry 
blankets. The efficacy of this treatment is increased by the use of a 
dose of bromide of sodium or potassium and a little chloral, as follows : 

R.— Chloralis gij (8.0). 

Sodii brorxrid ^ss (16.0). 

Aqufe dest q. s. ad fjiij (90.0).— M. 

S. — A teaspoonful (4.0) in water every five hours for three doses. 

COLIC (HEPATIC). 

This exceedingly painful condition, due to the passage of a gall-stone 
through the bile-duct, is always associated with faintness and nausea. 

The object of the physician must be to relieve this pain, not only 
by the use of anodynes, but also by aiding in the escape of the stone 
into the bowel. To relieve the pain a hypodermic injection of mor- 
phine J to J grain (0.015-0.03), accompanied by T ^ grain (0.0006) of 
atropine, is indicated. The morphine not only decreases the pain, 
but allavs spasm, and the atropine relaxes the spasm of the muscular 
coats of the ducts and allows the stone to pass through the relaxed 
passage-way. Hot applications, such as turpentine stupes, may be 
used over the liver, but relaxation is not to be obtained by the use of 
nauseating emetics, as the retching or vomiting may rupture the dis- 
tended gall-bladder. Severe rubbing should not be used for the same 
reason. 

Quite recently the use of olive or cotton-seed oil has been largely 
resorted to in this affection, and, while we are not sure of the means by 
which it acts, the studies of Rosenberg and others point to the chang- 



570 DISEASES. 

ing of the oil into glycerin and fatty acids, the first of which liquefies 
and increases the flow of bile. Often the large dose of oil causes 
nausea, and this by producing general relaxation may aid in the escape 
of the stone. The oil is used during the attack of pain, and must be 
swallowed in the dose of half a pint at least; smaller quantities do 
not suffice. Its action may be aided and its retention in the stomach 
promoted by the addition of a drachm of ether to each dose. 

Shortly after the oil is swallowed sudden relief often occurs, due 
to the escape of the stone into the bowel. The stools should then be 
carefully watched for gall-stones, but care should be taken that the 
lumps of soap which are passed, made from the oil by the alkaline 
juices in the intestines, are not mistaken for true biliary calculi. If 
the pain does not yield to morphine, chloroform or ether may be 
inhaled for the relaxation of the spasm and the relief of pain. 

In the endeavor to render our treatment of a patient with gall-stones 
rational, we naturally study the causes which induce their formation 
and the manner in which we can expel those stones which have formed 
before the case has come under proper care or in spite of any preven- 
tive measures which we may have attempted. Unfortunately, we are 
met at the very beginning of our study by the fact that the physiologist 
and pathologist have not as yet discovered the exact characteristics of 
the general systemic conditions which underlie their formation ; but, 
on the other hand, experimental and clinical studies have developed 
a number of facts which are of great value to us. Thus, we now know 
that there are a number of local causes which distinctly predispose to 
the formation of gall-stone, and that these causes are very commonly 
found in that very class in which the systemic tendency to stone-forma- 
tion is most marked. In the first place, a catarrhal state of the biliary 
passages favors the formation of gall-stone by providing an excess of 
mucin, with the aid of which the stone may be built ; secondly, this 
catarrhal state is commonly associated with, or produces of itself, a 
diminished alkalinity of the bile, whereby the cholesterin becomes more 
readily precipitated, and at the same time, it would appear, causes the 
deposition of an abnormal amount of lime salts, brought from else- 
where in the body and passed out through the mucous membrane. 
This latter fact seems proved by the circumstance that bile itself con- 
tains very little lime, and that more lime is found in stones lying against 
markedly catarrhal mucous membranes than in stones not so situated. 
So far, then, we have a simple pathological process providing no less 
than three ingredients of stone-formation — namely, mucin, cholesterin, 
and stearate, or some other salt of lime. There are still two other im- 
portant factors at work — namely, the systemic state, gouty or otherwise, 
which tends to stone-formation, and the stasis of the bile in its ducts, 
because the catarrhal process in the mucous membrane blocks its pas- 
sage toward the bowel. 

Recognizing these etiological factors, it now becomes our duty to 
oppose them, and we have the following indications to fulfil : 1. By 
causing a free secretion of bile to produce a rapid flow of fluid which 
shall be normally liquid and probably normal in its constituents. 2. 
By the use of alkalies to antagonize the development of acid tenden- 



COLIC, HEPATIC. 571 

cies and to aid in the solution of mucus. 3. By regulating the diet 
prevent those hepatic and systemic disorders which tend to the forma- 
tion of stone. 4. As catarrhal states are often due to or aided by 
bacterial infection, to produce intestinal asepsis as far as possible. 

The normal secretion and flow of bile is best brought about by exer- 
cise of a gentle and wisely-directed nature, taken continually and evenly, 
and particularly those forms of exercise which call into play the abdom- 
inal muscles and diaphragm or cause hepatic movements. The chief and 
best of these is horseback riding, or, if the patient is too feeble for this, 
massage should be resorted to, the hypochondrium being well but gently 
kneaded and rubbed daily for a considerable period of time. If the 
liver seems very torpid, calomel in small divided doses of a fraction of 
a grain may be given several times a week, or nitro-muriatic acid may 
be more rarely used. In other instances, where there is reason to 
believe that the flow is sluggish and the bile not sufficiently alkaline, 
that catarrh and putrefactive tendencies are present, the administration 
of benzoate of sodium, or salicylate of sodium, in 10- or 20-grain doses, 
will result in increasing the flow, increasing the alkalinity, overcoming 
the catarrh, and then to arrest intestinal putrefaction. If the catarrhal 
process is very marked, chloride of ammonium will act even more satis- 
factorily. This treatment seems especially valuable when the stones 
that are passed are very dark in color, indicating that much pigment 
and little cholesterin is present. In respect to the use of alkalies, the 
patient should drink freely of those mineral waters which will provide 
alkaline substances, such as Contrexeville, Vichy, and Kronenquelle, 
and it is useful in many such cases to relieve any tendency to constipation 
or duodenal catarrh by the administration of hot Carlsbad water before 
breakfast daily. In the matter of regulating the diet, all rich or fatty 
foods are to be prohibited. Meat should be used in moderation, prefer- 
ably white meats, and green vegetables largely eaten. 

The catarrhal condition, associated with marked bacterial infection, 
as may be evidenced by some febrile movement, is best controlled by 
the use of turpentine, chloroform, and ether, given internally, and 
accompanied by the application externally of hot poultices to the 
hepatic area. These poultices may or may not be fortified by mustard, 
and when removed should be replaced by a warm pad to prevent any 
chilling of the surface of the body. 

Of the internal remedies just named, turpentine is the most useful, 
since it liquefies mucus, aids the flow of bile, and is thought by some 
physicians to cause the expulsion of the stone by stimulating the walls 
of the ducts, and that it dissolves the stone. Further than this, its 
continual use seems to prevent the formation of stone. Ralfe states 
that it is best given as follows : 

R.— 01. terebinthinse Ti\,v (0.35). 

Syrup, acacise f^ss (15.0) 

Sodii sulph. carbolat gr. xx (1.35). 

Spt. setheris composit 1T\,xv (1.0). 

Aquae menthae piperita? q. s. f^j (30.0). — M. 

S. — To be taken twice or thrice a day. 

We would prefer adding compound spirit of lavender instead of pep- 



572 DISEASES. 

permint-water. If this mixture cannot be retained by the stomach, the 
turpentine may be given in capsule, and followed by a draught of milk. 
Finally, a most important factor in the prevention of gall-stone 
formation in susceptible persons is the avoidance of exposure and wet, 
and, if possible, a residence in a sunny climate during winter months. 

CONJUNCTIVITIS. 

Simple Conjunctivitis, sometimes called catarrhal, acute, or muco- 
purulent ophthalmia, is characterized by congestion of the conjunctiva, 
loss of transparency of the palpebral portion, and some dread of light, 
with a discharge sufficient only to glue the lids in the morning or free 
and muco-purulent. In the milder stages the use of a boric-acid lotion 
(10 grains to the ounce [0.65 : 30.0]) is suitable, and the lids should 
be frequently washed with neutral soap and water ; if there be much 
muco-purulent discharge, the lid should be everted and an application 
made of a solution of nitrate of silver (from 2 to 5 grains to the ounce 
[0.1-0.35 : 30.0]). If the discharge becomes great, bichloride of 
mercury, 1 : 10,000, may be employed with advantage, and the nitrate- 
of-silver solution increased to 10 grains to the ounce (0.65: 30.0), the 
excess being neutralized with a solution of salt or washed away with 
tepid water. Much inflammatory reaction in this disease may be alle- 
viated by iced compresses. Patients suifering from catarrhal conjunc- 
tivitis should be protected from tobacco-smoke, bright light, dust, or 
any mechanical irritant. Atropine usually is unnecessary unless a 
corneal ulcer complicates the affection. The patient may wear smoked 
glasses, but under no circumstances must the eyes be bandaged or have 
poultices applied to them. Domestic medication of this sort may change 
a simple ophthalmia into a serious and purulent inflammation. Topi- 
cal medications other than those mentioned are biborate of sodium 
(gr. iv-viij to the ounce), alum (4 to 8 grains to the ounce [0.3-0.5: 
30.0]), sulphate of zinc (1 to 2 grains to the ounce [0.05-0.1 : 30.0]), 
which may be suitably combined with boric acid, creolin, 1 per cent, 
solution, and peroxide of hydrogen. During the subsidence of the 
inflammation, and if it shows any tendencv- to become chronic, the 
application of an alum crystal or a solution of tannin and glycerin (10 
grains to the ounce [0.65 : 30.0]) is suitable. It should be remembered 
that muco-purulent conjunctivitis may become epidemic in crowded 
institutions, and great care should be taken to isolate cases. One 
soiled towel may be the source of infection to a great number of chil- 
dren. Constitutional treatment ordinarily is not required, but proper 
hygiene, fresh air, good food, the intelligent use of laxatives, and tonic 
doses of quinine are useful. Conjunctivitis may be associated with 
nasal catarrh, bronchitis, a general cold, eczema of the face, and the 
exanthemata. 

Acute contagious conjunctivitis, vulgarly known as "pinkeye," 
does not greatly differ in its manifestations from ordinary simple con- 
junctivitis, except that it is more violent and is more apt to be associ- 
ated with hemorrhages beneath the conjunctiva. As its name indicates, 
it is highly contagious,, and sometimes appears in an epidemic form. 



CONJUNCTIVITIS. 573 

It is due, in the great majority of instances, to the Koch- Weeks 
bacillus. A very similar form of epidemic conjunctivitis is caused 
by the pneumococcus. The treatment is the same as that already 
described. A solution of sulphate of zinc, 1 or 2 grains to the ounce, 
is particularly efficacious. 

Burns of the Conjunctiva. — Immediately after the accident, all 
foreign particles should be removed ; then a few drops of cod-liver oil 
may be instilled and atropine employed (suitably incorporated with 
liquid vaseline) to prevent iritis. The chief danger lies in the forma- 
tion of severe corneal inflammation and symblepharon ; the latter may 
sometimes be prevented by daily breaking up the granulation-tissue or 
by the insertion of a piece of gold-beaters' skin between the inner sur- 
face of the lids and the eyeball. The associated conjunctivitis and 
keratitis require treatment differing in no way from that described in 
connection with idiopathic forms of these affections. 

Purulent Conjunctivitis, which is commonly seen in the adult in 
the form of gonorrhceal ophthalmia and in the infant as ophthalmia 
neonatorum, is produced in both varieties by the introduction into the 
eye of a specific virus from either the urethra or the vagina. The 
chief danger of the disorder is destruction of the vitality of the 
cornea and loss of sight. The most important indication is to pre- 
vent this danger by reducing the amount of swelling of the lids and 
conjunctiva and the profuse discharge, which are the characteristics 
of the disease. These indications are met best in the following man- 
ner : Hourly cleansing of the eyes with an antiseptic solution, pref- 
erably bichloride of mercury (1 : 8000), formaldehyde 1-3000, or a 
saturated solution of boric acid. During the acute inflammatory stage, 
and before the discharge is profuse, astringents and cauterants must 
not be applied. When this stage has arrived and the conjunctiva is 
profusely covered with discharge, the lids should be carefully everted 
once a day, wiped clean of every particle of pus, and carefully touched 
with a solution of nitrate of silver (10 to Z(J grains to the ounce 
[0.65 : 30.0]), and the excess neutralized with a few drops of a solu- 
tion of common table salt. In the early stages iced compresses wrung 
out of carbolized water and frequently changed will help to reduce the 
reaction, or these compresses may be made by placing squares of lint 
upon a block of ice and thus securing intense cold. If the vitality of the 
cornea is threatened, it is advisable, in many instances, to substitute 
for the cold applications hot compresses of a temperature of 110° F. 
These may be applied for from ten to twenty minutes every two or 
four hours, according to the exigencies of the case. The appearance 
of ulceration in the cornea calls for the use of atropine. In adults 
high reaction and violent inflammation may be alleviated by the use 
of leeches to the temple. Bleeding of any sort is not applicable to 
new-born infants. Other applications which have met with favor 
are : alum (grains 4-8 to the ounce), sulphate of zinc (grains 2 to 
the fluidounce), aqua chlorini, cyanuret of mercury (1 : 1500), per- 
manganate of potassium (1 : 2000) employed in copious irrigations, 
formaldehyde (1 : 3000), argentamin (1 : 5000), and protargol (4-5 per 
cent, solution, applied to the everted mucous membrane, or a. \ to \ per 



574 DISEASES. 

cent, solution used as a collyrium). The preventive method of treating 
ophthalmia neonatorum that has obtained the happiest results is that 
instituted by Crede' — namely, the dropping of a 2 per cent, solution of 
nitrate of silver into the eyes of the new-born infant. This method 
should be employed in all infected cases, or cases from which the sus- 
picion of infection has not been removed ; but it is unnecessarily 
severe if previous examination has demonstrated the entire absence 
of infection. Under the last-named condition careful cleansing of 
the lids of the eye and flushing of the conjunctival sac with a mild 
antiseptic lotion are usually sufficient. If it is desired to employ 
silver, 1 : 500 is the strength. There is some evidence to show that 
protargol is useful under these circumstances. If one eye alone is 
attacked, the other should be protected by covering it with a Buller 
shield, which consists of a watch-glass fixed in a square of plaster, 
which is applied so that the crystal comes directly in front of the 
eye, and the plaster covers the surrounding area. 

Chronic Conjunctivitis may result from an antecedent acute inflam- 
mation of the conjunctiva or exist as an idiopathic affection, especially 
in elderly people, in whom it sometimes becomes a troublesome symp- 
tom, especially if complicating cataract. The characteristic lesions are 
roughness of the papillae of the conjunctiva, swelling of the caruncle, 
and soreness of the angles of the eyelids. There are no granulations, 
although the disease is sometimes inaccurately spoken of as granular 
lids. A soothing wash is indicated (10 grains of boric acid to the 
ounce [0.65 : 30.0] of water), to which may be added 2 grains (0.1) of 
cocaine, provided the cornea is not ulcerated, and for which a similar 
boric-acid lotion with 4 grains (0.3) of salt to the ounce (30.0) may be 
substituted. A very suitable local application is lapis divinus (sul- 
phate of copper 1 part, alum 1 part, nitrate of potassium 1 part, 
fused together, and camphor equal to one-fiftieth of the whole 
added. The mass is run into sticks, and the application made to the 
everted lips, or 1 grain (0.05) of the same preparation to the ounce 
(30.0) of water may be dropped into the eye). Other useful applica- 
tions are tannin and glycerin (10 grains to the ounce [0.65 : 30.0]), 
yellow-oxide of mercury salve, and alum crystal. If refractive error 
exist, this should be corrected. It is to be remembered that chronic 
conjunctivitis distinctly contraindicates any operative interference in 
the eye, as, for instance, cataract extraction. There is an interesting 
form of chronic conjunctivitis, or, perhaps, more accurately, subacute 
conjunctivitis, which runs a course lasting from eight weeks to several 
months, and which is characterized by very slight objective symptoms, 
that is due to the presence of the diplobacillus of Morax and Axenfeld, 
and which is promptly cured by the application of a solution of sulphate 
of zinc, 1 or 2 grains to the ounce. The conjunctival secretion of stub- 
born cases of conjunctivitis should always be examined for this bacillus. 

Lachrymal Conjunctivitis is a name given to a chronic form of 
inflammation of the conjunctiva, associated with obstruction in the 
lachrymal duct, and characterized by a tear-soaked appearance of the 
eye, small pustules at the roots of the lashes, and a gummy discharge 
along the palpebral margin. This can be cured only by relief of the 



CONJUNCTIVITIS. 575 

stricture of the nasal duct which causes it, but may be alleviated with 
the same remedies recommended in the treatment of chronic conjunc- 
tivitis. Good results are reported from the use of pyoktanin. 

Follicular Conjunctivitis — a disease sometimes mistaken for granular 
lids, but having a distinct clinical difference, inasmuch as the swollen 
follicles are absorbed without the production of cicatricial changes in 
the conjunctiva — requires for its local treatment weak astringents and 
antiseptic lotions, and the application to the swollen follicles of an 
ointment of sulphate of copper (gr. J to the drachm [0.025 : 4.0]), 
dusting in calomel either alone or with equal parts of subnitrate of 
bismuth, or iodoform or aristol used in the same way. If the disease 
is stubborn, the swollen follicles should be crushed with forceps. 

This disease, or one analogous to it, is sometimes produced by the 
prolonged instillation of atropine, and less frequently by eserine and 
cocaine. If this is its cause, the drug must be suspended and the 
surface painted with an alum crystal. 

Granular Conjunctivitis. — This disease may be divided into acute 
and chronic granulations. In the former astringents and caustics are 
inadvisable, the eyes requiring weak antiseptic solutions like boric 
acid or salicylic acid and the instillation of atropine. Leeches to the 
temple will aid in reducing the inflammatory reaction. In the chronic 
disease the object of treatment is to bring about absorption of the 
granulations which are its characteristic lesion, not by an application 
so caustic as to destroy the mucous membrane around them, but of 
sufficient vigor to produce healthy reaction. The following applica- 
tions comprise those which have been employed with the greatest 
success: 10-grain (0.65) solution of nitrate of silver if there is dis- 
charge, applied once a day with neutralization of the excess ; sulphate 
of copper in the form of a crystal, carefully applied to the everted 
lids and the retrotarsal folds ; glycerole of tannin (tannic acid 
grs. 30 [2.01, glycerin 1 oz. [80.0]), best applied with a cotton 
applicator ; boroglyceride from 20 to 50 per cent, according to 
the vigor of the granulations. Strong solutions of corrosive sub- 
limate are employed in the following manner : Solutions of the 
strength of 1 : 300 or 1 : 500 are painted on the everted lids every 
second day, the pain of the application being alleviated by the pre- 
vious instillation of cocaine, while three times daily the eyes are 
irrigated thoroughly with a solution of the mercury salt, 1 : 7000. 
Among the many other applications which may be used in this disease 
the following niay be mentioned : liquor potassa, beta-naphthol, iodo- 
form or aristol in powder or salve, an ointment of the yellow oxide 
of mercury, calomel, and hydrastin. The surgical means which are 
employed to destroy the granulations are scarification of the con- 
junctiva, an inadvisable method; excision of the granulations, use- 
ful if these exist in isolated groups; crushing the granulations with 
specially devised forceps, a method often followed by satisfactory 
results ; scarification, followed by a vigorous brushing of the aifected 
tissue with a brush containing short bristles, previously dipped in a 
strong (1 : 500) solution of corrosive sublimate (Grattage) ; electrolysis ; 
and excision of the fornix conjunctiva. In long-standing cases asso- 



576 1 DISEASES. 

ciated with inveterate pannus De Wecker has proposed the use of an 
infusion of jequirity (3 per cent.). This produces an intense mem- 
branous conjunctivitis, which must be treated by iced compresses or 
similar measures to reduce its reaction, but when it has subsided the 
pannus is often relieved. This method has not been employed in 
recent times to the extent that it was practised when first introduced. 

Diphtheritic Conjunctivitis is rare in this country, but on the con- 
tinent of Europe occasionally occurs as an epidemic. It may appear 
alone or in association with diphtheria of the throat and nose. The 
initial subjective symptoms are those of purulent ophthalmia; the 
characteristic objective symptoms, a board-like infiltration of the lids 
with a deposit of gray membrane upon the palpebral conjunctiva. 
More than in any other eye disease destructive inflammation of the 
cornea is threatened. In the early stages the eye should be fre- 
quently cleansed with boric-acid or bichloride-of-mercury solutions, 
and atropine instilled, while hot compresses help to maintain the 
nutrition of the cornea more perfectly than the cold compresses which 
were formerly recommended for antiphlogistic purposes. Tweedie 
has highly recommended a solution of quinine (3 grains to the ounce 
[0.25 : 30.0]); Burgomaster, insufflation of flowers of sulphur; while 
in France the local application of lemon-juice or citric-acid ointment 
has been endorsed ; Galezowski uses oil of cade (1 : 10). In the 
early stages all caustics are contraindicated ; after absorption of the 
membrane and re-establishment of the discharge the cautious use of 
nitrate of silver in the manner described under Purulent Ophthalmia 
may be employed. The constitutional measures for diphtheria are 
necessary and the best treatment is the employment of injections of 
diphtheria antitoxin. In recent times the best results in diphtheritic 
conjunctivitis have been secured by the administration of diphtheritic 
antitoxin in the ordinary manner. 

Chemosis of the Conjunctiva, in which this membrane is infiltrated 
with serum, is usually a symptom of other ocular disorders, and sub- 
sides with the general treatment directed to their relief. Good results 
may follow nicking the swollen tissues with a pair of scissors, the 
application of a warm, moist compress, and the use of astringents, 
especially alum. 

Hemorrhage beneath the Conjunctiva (subconjunctival ecchymosis) 
may follow an injury, occur during a paroxysm of whooping-cough, 
and occasionally, in elderly people, may appear spontaneously. Recur- 
ring subconjunctival hemorrhages in elderly people are indicative in 
many instances of renal disease, having much the same significance as 
hemorrhages in the retina. No treatment materially hastens the 
absorption of the blood, unless it be massage of the globe through the 
closed lid ; any associated conjunctival irritation may call for a boric- 
acid and cocaine wash. 



CONSTIPATION. 

This troublesome state depends on a number of causes, the most 
common of which is the following of a sedentary life totally devoid 



CONSTIPATION. . 577 

of the exercise intended to keep the intestinal and hepatic secretions 
in an active state. Another frequent cause is simple laziness, which 
causes the patient to resist the call of the bowel for evacuation until 
this part of the body becomes indolent and atonic, while modesty 
often causes constipation in females, because a woman prefers to suf- 
fer rather than go to a closet which may be somewhat publicly sit- 
uated. In other instances constipation seems to be hereditary, and 
to depend upon deficient nerve-supply or muscular weakness and lack 
of secretion in the lower bowel, or upon hepatic torpor. 

Whatever the causes are, they should be sought for, and, if pos- 
sible, removed, the physician not being content to order purgatives, 
which, while they may give temporary relief, soon lose their power. 

Further than this, it must be remembered that hygienic measures 
always take first place in the method of treatment, and, if possible, 
drugs should occupy a very secondary role. Particular attention 
should be paid to diet, and the physiology of peristalsis must be well 
borne in mind. 

It has been proved by a large number of studies, both in the nor- 
mal intestine and by the use of purgatives, that peristalsis is almost 
entirely a reflex action depending for its existence upon the integrity 
of the nervous plexuses in the intestinal walls — namely, those of - 
Auerbach and Meissner — the first of which are situated between the 
longitudinal and circular muscular fibres which they supply, the latter 
existing in the submucosa and supplying the walls of the villi, the 
glands of Lieberkiihn, and the small arteries and venules. 

It has also been found that the vagus nerve, when stimulated 
reflexly or directly, increases peristalsis, and that moderate stimula- 
tion of the splanchnic nerves decreases it. 1 It at once becomes evi- 
dent that any decrease in the normal activity of these nerves and 
nerve-centres must speedily result in constipation, and the costive 
condition consequent upon hepatic torpor is due to the fact that the 
intestinal walls do not receive the proper stimulation from the bile to 
set in motion a reflex peristaltic wave the result of which will be 
evacuation. This fact rests upon the results of direct experiments, 
which prove the bile to be primarily an intestinal stimulant, antisep- 
tic, and promoter of secretion. 

Other series of experiments have shown that the circulation of the 
blood through the intestines greatly influences peristalsis, and disor- 
ders in the blood-supply readily bring on intestinal disorder. 

The deductions to be drawn from these facts are many. In the 
first place, it is evident that the maintenance of an active, normal 
circulation of blood in the abdomen and a free pouring out of bile 
from the liver and gall-bladder are necessary to a healthy peristalsis; 
and we find that, aside from drugs, we have a number of remedial 
measures which are to be resorted to according to the means of the 
patient. By far the best of these is horseback exercise for at least 
an hour a day or every other day, which by the motion actively stirs 

1 Some persons believe that Meissner's plexus receives impulses from the walls of 
the inlestine and transmits them to the motor plexus of Auerbach, which then sets in 
motion peristalsis. 
37 



578 DISEASES. 

up and excites the abdominal viscera as no other measure can do. If 
for any reason horseback exercise is impossible, then abdominal mas- 
sage, carried out by a capable " rubber," is to be tried, the hands fol- 
lowing more particularly the course of the ascending, transverse, and 
descending colon, the kneading movements being also applied to the 
hypochondriac regions. If neither of these measures can be used, 
then the patient must resort to those gymnastic movements which 
involve the abdominal muscles, either by the use of dumb-bells or 
pulleys, such as are sold under the name of "home gymnasiums," or 
by bending the body forward, backward, and laterally, with the fists 
pressed into the hypogastrium. 

At the same time that these measures are directed the diet of the 
patient must be so regulated that the food shall contain a large amount 
of residue — that is, after digestion enough of the husk of the grain or 
enough vegetable fibre must be left free in the intestines to form a 
stimulus to the intestinal wall as it slips over the mucous membrane. 
If a meat diet is largely used, so little residue is left after digestion 
that constipation ensues, but if vegetables are largely eaten the reverse 
is the case. No better evidence of this can be adduced than the hard, 
clay-like passages of the dog and the soft passages of the cow. Very 
often a plateful of cracked wheat (wheaten grits) eaten at breakfast 
each morning, or the use of bran bread, will relieve a chronic tendency 
to constipation. In these cases milk as a prominent article of diet is 
to be avoided above all things, since it is almost entirely assimilated 
and leaves no residue, though it supplants other foods. Green or 
canned corn is of great service. Fruits do good in constipation in 
one of two ways — they either contain residual materials or sufficient 
vegetable acid salts to be laxative. Figs, by reason of their many 
small seeds, which scrape the mucous membrane during peristalsis, 
are particularly valuable, and apples, prunes, dates, and tamarinds 
are all useful. It must be remembered that strawberries, raspberries, 
and blackberries are generally constipating rather than purgative. 
In regard to drink, nothing is so good as a glass of cold water taken 
on arising in the morning or just before breakfast, or, if the cold 
cannot be borne, then a glass of as hot water as can be swallowed 
with comfort may be substituted. Coffee is constipating to most per- 
sons, largely because of its empyreumatic oil, and tea has the same 
tendency because of its tannic acid. Brandy, as every one knows, 
is distinctly constipating, and whiskey possesses so little power to the 
contrary as to be devoid of influence in either direction. Beers differ 
in their properties, some of them increasing and some of them decreas- 
ing intestinal activity. 

The patient suffering from constipation should go to stool regularly 
after breakfast every day even if the attempt is abortive, and so train 
the bowel to having a movement at this time. 

The use of drugs for the relief of constipation is capable of division 
into two parts : first, the employment of remedies to unload the bowel, 
which has become filled; second, the use of drugs which will so influ- 
ence the intestines as to cause evacuation and produce normal activity, 
or. in other words, drugs which will cure the tendency instead of 



CONSTIPATION. 579 

giving temporary relief. Of the first class we find the various pur- 
gative salts, jalap, colocynth, senna, mercury, castor oil, and rhubarb ; 
of the second class, aloes, cascara sagrada, manna, tamarinds, rhamnus 
frangula (buckthorn), phosphate of sodium, and small doses of podo- 
phyllin. The physician should bear in mind that defecation is a nor- 
mal physiological act which must be continued all through life, and it 
is almost as foolish to stimulate the bowel continuously to peristalsis 
as to perpetually employ heart stimulants or respiratory excitants. 

Although they are habitually employed by many persons in daily 
doses, the purgative salts are exceedingly harmful in such instances, 
rapidly losing their power and decreasing the patient's strength by 
the abstraction of liquids and salts from the blood. They often pro- 
duce anaemia when constantly used. These salines are to be employed 
simply to unload the bowel when an excess of faecal matter has accu- 
mulated or when irritant materials are to be swept out of the aliment- 
ary canal. In some cases of pelvic congestion associated with con- 
stipation magnesium sulphate may be given by enema in the propor- 
tion of 2 ounces (60.0) of the salt, 1 ounce (30.0) of glycerin, and 4 
ounces (120.0) of water. In some rare instances, where great pleth- 
ora exists, a course of Hunyadi water, Friedrichshall or Carlsbad 
waters is of service, but these instances are rare indeed in America. 
Jalap, colocynth, and senna are not to be used constantly, as they 
are too active and the reaction from their effects causes constipation. 
Rhubarb is commonly used, but is of its class peculiarly unfitted to 
its task. Although it purges, it is distinctly astringent, and is there- 
fore more constipating in the end than if no drug had been used. 

Mercury is exceedingly harmful if used continuously as a purge, and 
is the cause of much ill-health, of bad teeth, and of digestive troubles. 
Castor oil is notorious for its tendency to cause ultimate constipation. 

Of the curative class of laxatives none compare to cascara sagrada, 
particularly in the form of the aromatic fluid extract or cascara cor- 
dial. Originally, this drug as prepared was very bitter, but it is now 
made almost tasteless by certain manufacturers. This is the only drug 
which alone moves the bowels and at the same time tends to make 
future passages more easy and regular; the dose is 10 to 40 minims 
(0.65-2.65) of the fluid extract or 1 to 6 drachms (4.0-24.0) of the 
cordial. There is almost no griping produced by it. For the regula- 
tion of the bowels of young children, particularly if the case have a 
tendency to rickets, phosphate of sodium in the dose of 5 to 10 grains 
(0.35-0.65) in milk is the best laxative, and the same salt may be used 
in 30- to 60-grain (2.0-4.0) doses in adults. Manna is to be classed 
as a laxative, but even it sometimes makes the intestinal torpidity 
ultimately much worse. The two remaining drugs of this class, aloes 
and podophyllin, should always be used in combination with other non- 
purgative drugs, as is seen in the following formula : 

R. — Aloes socotrinae gr. xx vel xl (1.3-2.65). 

Extract, nucis vomicae gr. iv (0.3). 

Extract, physostig gr. iij (0.25). 

Extract, belladonna? gr. iv (0.3). — M. 

Ft. in pil. No. xx. 
S. — One pill at night or night and morning. 



580 DISEASES. 

Or, 

R .— Resinre podophylli gr. ij vel iv (0.1-0.3). 

Extract, nucis vomicse gr. iv (0.3). 

Extract, physostig gr. iij (0.25). 

Extract, belladonna? gr. iv. (0.3). — M. 

Ft. in pil. No. xx. 
S. — One night and morning. 

The object of using several of these drugs is seen at a glance. 
We have already learned that nearly all purgatives tend to produce 
griping. The nux vomica acts as a bitter tonic and stimulant, and 
prevents subsequent atony of the mucous membrane, as well as increases 
reflex action, and consequently improves peristalsis ; the physostigma 
is a tonic to the unstriped muscular fibre and gives it strength ; the 
belladonna aids peristalsis by depressing the inhibitory fibres of the 
splanchnic nerves, by allaying spasm, and by decreasing griping. In 
using these drugs, aloes and podophyllin, we should remember that 
aloes is slow and acts particularly on the lower bowel, and that podo- 
phyllin acts chiefly on the upper bowel and is the slowest purge in 
the list of purges. 

In obstinate constipation we are sometimes forced to resort to the 
compound cathartic pill of the U. S. .P., or its modified form known as 
the " Pilula cathartica vegetabilis " (see Colocynth). After the bowels 
have been well emptied by this pill we can often regulate them by cas- 
cara sagrada with or without other laxatives, and by prescribing a 
proper diet and exercise. 

In the flatulence of old persons associated with constipation a 
little asafoetida or capsicum should be added to the pill of aloes 
just named. 

In some instances constipation arises from reflex irritation or from 
ovarian or bladder trouble or from chronic lead poisoning. This form 
of constipation may resist all purgatives and yield to opium or to 
tobacco, which quiets reflex action. Tobacco depresses the inhibitory 
nerves of the gut, and devotees of the " weed " often use it as a lax- 
ative. 

The employment of enemata as a routine practice is to be discour- 
aged. In cases where it is necessary to use them for temporary relief 
and to get rid of flatulence, a little soap, common -salt, or a few drops 
of turpentine may be added to the water. Recently the injection of 
glycerin (1 to 2 ounces [30.0-60.0]) has been largely resorted to, 
either pure or diluted one-half, and this method has been improved 
upon by the use of glycerin suppositories containing many drops of 
the drug. Glycerin acts in these cases as an irritant to the mucous 
membrane, and causes secretion by this means and by its abstraction 
of water from the tissues by reason of its hygroscopic powers. It is 
capable, however, of causing a good deal of rectal irritation in some 
persons. 

CORNS. 

These troublesome formations are best treated by the use of sali- 
cylic acid, the following formula being applied night and morning for 



CORYZA, ACUTE. 581 

several days, after which the part should be well soaked in hot water, 
when the entire corn will readily come away, or in some cases several 
attempts will be necessary : 

R— Acid, salicylic gr. xxx (2.0). 

Extract, cannab. indicse gr. x (0.65). 

Collodii > f ifss (16.0).— M. 

S. — Apply with a camel's-hair brush. 

The same acid may be used in alcohol, and lactic acid in the same 
proportion is often of service. 

In the so-called "soft corns," with much inflammation, the foot 
should be washed and dried, and a saturated solution of nitrate of 
silver, 60 grains (4.0) to 2 drachms (8.0), applied to the part every 
four or five days. 

CORYZA (ACUTE). 

The treatment of coryza of the acute variety, the form which most 
frequently presents itself to the physician for relief, is followed in 
many instances by such marked amelioration of the symptoms and 
shortening of the attack as to encourage medical interference. It 
must be remembered, however, that the duration of the condition 
before the patient presents himself has much to do with the progno- 
sis, for if the tissues of the nasal chambers have become boggy and 
swollen with exudation recovery must be more prolonged than if rem- 
edies are applied in the early stages of the catarrhal process. The 
local treatment consists in the following measures for relief: By 
means of a medicine-dropper or an atomizer a few minims of a 4 per 
cent, solution of cocaine are dropped into the nostrils, the patient's 
head being well tipped back. After the peculiar constringing influ- 
ence of the cocaine has shrunken the congested mucous membrane, 
so that the patient can draw air through the nostrils, the nasal cham- 
bers should be washed clean of mucus by means of the following 
lotion in an atomizer: 

R. — Sodii chloridi , gr. xv (1.0). 

Acid, boric gr. x (0.65). 

Sodii borat gr. x (0.65). 

Aquae dest fgiij (90.0).— M. 

The parts being thoroughly cleansed, a fine spray of the following 
should be used as antiseptic, sedative, anaesthetic, and protective : 

R .—Menthol gr. viij (0.5). 

Camphor gr. v (0.3). 

Albolene f £j (30.0).— M. 

In this prescription the menthol exerts an anaesthetic effect, and pro- 
longs the constriction of the parts produced by the cocaine, so avoid- 
ing the secondary capillary dilatation due to that drug. The camphor 
exercises its well-known soothing influence, and the albolene protects 
the membrane from dust and irritants. If the congestion has a tend- 
ency to return, it is well to use a solution of antipyrin, 2 to 4 grains to 



582 DISEASES. 

the ounce (0.1-0.2 : 30.0) of water, as a spray to prolong still further 
the effect of the cocaine. The albolene spray should follow, not pre- 
cede, the antipyrin, as the oil would prevent the antipyrin from acting. 
Under no circumstances should the antipyrin be used without the 
cocaine preceding it, as the pain is too severe. 

The interna] treatment consists in the very beginning of the attack 
in the use of the formula for this purpose composed of belladonna, 
camphor, and quinine, and recommended in the article on Camphor. 
A hot foot-bath, with mustard in it, and the taking of a hot drink, 
such as lemonade with whiskey in it, on going to bed, are useful. Often 
20 or 30 minims (1.3-2.0) of sweet spirit of nitre added to this drink 
will increase its diaphoretic effect. In other cases, particularly in 
strong, hearty men, 5 to 10 grains (0.3-0.65) of Dover's powder at 
bed-time will be better. This line of treatment is of little value after 
secretion has been fairly established, and in its place supportive meas- 
ures are indicated. Small tonic doses of quinine, 2 to 4 grains (0.1- 
0.2) three times daily, sometimes combined with the use of 5 to 10 
grains (0.3—0.65) of chloride of ammonium, as prescribed in the article 
on Bronchitis, are useful. Where much headache is present full doses 
of the bromide of potassium or sodium are to be given, and the spray 
treatment already named for the purpose of cleansing the nasal cham- 
bers is to be persisted in while the attack lasts, but the cocaine ought 
not to be employed at this time unless absolutely needed. (See Cam- 
phor.) 

CROUP. 

(See Diphtheria.) 



CROUP (SPASMODIC). 

As this is a spasm of the glottis depending for its causation upon 
catarrh of the mucous membrane of the larynx, and as it is due most 
commonly to some reflex irritation, such as dentition, indigestible 
food, or sudden atmospheric changes, or to rachitis, the treatment 
is both prophylactic and curative. Prophylaxis consists in the avoid- 
ance of cold, the use of a simple diet, particularly at the evening meal, 
the rendering of the air of the bedroom moist by means of steam, 
or at least by the avoidance of dust-laden, furnace-heated air, and by 
the removal of dental irritation and nasal hypertrophies, which make 
the child a "mouth-breather." Much relief can be provided such 
patients by having them sleep in a " bronchitis-tent." (See article on 
Bronchitis.) Small doses of the bromides, chloral, belladonna, or opium 
may be resorted to at bedtime. A very useful prescription for this 
purpose is that which follows : 

R.— Sodii bromidi i\ (4.0). 

Syrupi lactucarii f^ij (60.0). — M. 

S. — Teaspoonful to a dessertspoonful (4.0-8.0) on going to bed, and once or twice dur- 
ing the night if needed. 



CYSTITIS, ACUTE. 583 

When the attack is present a cold cloth should be wrapped about 
the neck and the child placed at once in a hot bath, the air of the 
room being moistened by the steam escaping from a kettle of boiling 
water or by pouring water upon unslaked lime. If the paroxysm is 
very severe, a few whiffs of amyl nitrite may be employed, or anti- 
monial wine in the dose of 2 drachms (8.0) may be used to cause vom- 
iting. It is also useful to disseminate the fumes of menthol through 
the air of the room by heating some crystals in an iron spoon. If 
the fumes are strong enough to produce a distinct odor, they are 
present in sufficient amount. 

The drugs first named do good by decreasing reflex excitability, 
while the emetics indirectly relax the spasm by the nausea and 
depression which they produce. 



CYSTITIS (ACUTE). 

If, by reason of exposure to cold, injury, the introduction of for- 
eign bodies, such as dirty catheters, or the presence of gonorrhoea or 
other disease due to a septic poison, an acute inflammation of the 
bladder ensues, it is accompanied by a sensation of weight and ves- 
ical fulness, by pain, tenesmus, and inability to retain the urine. 
Sometimes the last-named condition may be reversed and retention 
of the urine be present. 

If the general system responds to the local inflammation, as evi- 
denced by increased arterial excitement and fever, aconite in full 
doses of the tincture should be used, and it should be combined with 
small amounts of sweet spirit of nitre and citrate of potassium, as 
follows : 

R.— Tinct. aconiti f&j (4.0). 

Spirit, aether, nitrosi fjj (30.0). 

Liquor potassii citratis q. s. ad f§vj (180.0). — M. 

S. — Dessertspoonful (8.0) every four hours until all fever ceases and the pulse is quiet. 

At the same time a hot compress should be applied over the blad- 
der, but it should not contain turpentine or any irritant substance 
which may be absorbed from the skin and when eliminated by the 
kidneys irritate the bladder-walls. Leeches may be placed upon the 
perineum or cups applied to the region of the sacrum. In some cases 
belladonna may be used with or without aconite in the dose of 5 to 
10 minims (0.65) of the tincture three times a day, and it is worthy 
of note that this drug is particularly serviceable in the cystitis due to 
cold; 5 minims of liquor potassa every four hours may be substituted 
for the citrate of potassium, or the acetate of potassium may be used. 
If there is much pain and bearing-down, an enema of 30 minims (2.0) 
of deodorized laudanum in 2 ounces (60.0) of starch-water may be 
employed, or the opium may be given in suppository. 

Sometimes a belladonna suppository is of more service, and an 
iodoform suppository will often relieve the pain by its local anaes- 
thetic effects, Hot enemata, without any drugs, are often valuable 



584 DISEASES. 

as a means of relief, and a hot sitz-bath is very efficacious. Can- 
nabis indica, if an active preparation can be had, is better than opium 
to relieve the pain, since it seems to affect the bladder favorably. 
The other curative measures are hygienic, and consist in the main- 
tenance of the recumbent posture, absolute physical and mental rest, 
the avoidance of all foods which are stimulating, as rare meats and 
hio-hlv-seasoned dishes, and abstinence from all varieties of alcoholic 
beverages. 

Should the inflammation be severe enough to become purulent, 
the physician should order salol in the dose of 10 grains (0.65) three 
times a day. This drug, being broken up in the bowel into carbolic 
acid and salicylic acid, is so eliminated that it renders the urine anti- 
septic. 

Laxatives are to be employed with persistence if the bowels are 
confined, and salines in the early stages are generally better than 
vegetable purges. 

Quinine should not be used against the fever, as it is contraindi- 
cated, owing to its irritant effects upon the bladder. 



CYSTITIS (CHRONIC). 

The treatment of chronic cystitis is entirely different from that of 
the acute form, and consists in the use of remedies which will stim- 
ulate the diseased mucous membrane, cause a normal secretion of 
mucus, and so influence the urine that the mucus already formed will 
be passed out and the fluid rendered alkaline or acid, as may be 
desired. When the secretion of mucus in large amount is persistent, 
the urine should be rendered alkaline by the use of liquor potassa or 
the citrate of potassium. The bitartrate of potassium, unlike the other 
vegetable salts of potassium, such as the acetate or bicarbonate, is 
eliminated as the bitartrate of potassium, and, as it is acid, cannot be 
employed. 

We acidify the urine when it is necessary to dissolve the phosphates 
and to prevent deposits in the bladder and elsewhere. The three best 
drugs for this purpose are urotropin in the dose of 5 grains (0.3) three 
or four times a day, boric acid in the dose of 5 to 10 grains (0.35- 
0.65), or benzoate of ammonium in the same amount three times a 
day. The rule may be laid down that if the urine is high-colored and 
is strongly acid, alkalies are useful ; whereas if it is light in color, but 
loaded with phosphates, urotropin should be employed. Urotropin or 
salol may be given to prevent decomposition of the urine in the 
bladder. 

One of the best measures for the relief of chronic cystitis is to irri- 
gate the bladder daily with pure warm w r ater or water containing bichlo- 
ride of mercury in the proportion of 1 : 10,000, as this washes away all 
mucus and uric-acid deposits and prevents irritation. Solutions of 
nitrate of silver have been used with great success where the urine is 
muco-purulent, and Thompson recommends the use of a solution of the 
Strength of 1 grain to 4 ounces (0.05:120.0) of water, gradually 



DIABETES INSIPIDUS— DIABETES MELLITUS. 585 

increased to 2 grains to the ounce (0.1 : 30.0). Others, such as Gard- 
ner, Richardson, and Potter, recommend the use of stronger solutions, 
5 grains to the ounce (0.35 : 30.0) of water, claiming that while these 
amounts may produce serious effects in some instances, they are very 
efficacious in obstinate cases. The physician should have at hand a 
solution of common salt, which he should inject into the bladder at 
once if the effect of the silver solution is too painful or seems excessive. 
This treatment is suited only to the most chronic cases. 

The remaining remedies which are employed internally in chronic 
cystitis are those which are directed to the improvement of the mucous 
membrane of the bladder, and consist of buchu in the form of the 
fluid extract in the dose of J to 1 drachm (2.0-4.0), well diluted; 
arbutin or ursin, 3 to 5 grains (0.25-0.35) ; or the fluid extract of 
uva ursi, dose 30 minims to 1 drachm (2.0-4.0). All of these are 
better fitted for the treatment of subacute than chronic cystitis, as they 
are not sufficiently active for the chronic forms. 

In cystitis of a very chronic type, with great vesical atony, strych- 
nine is of service, and drop-doses of tincture of cantharides do great 
good. Turpentine may also be used with advantage in 5- to 20-minim 
(0.3-1.3) doses, as may also the oils of eucalyptus, sandalwood, cubebs, 
and copaiba. 

All these measures are suitable for the treatment of cystitis in the 
male and female, but it is to be noted that injections into the female 
bladder are made much more readily than into that of the male, because 
of the shortness of the female urethra. In either case the operation 
is best performed by attaching a small funnel to a soft-rubber catheter 
and filling the bladder by raising the funnel when full of water above 
the patient's belly. Creolin has been highly recommended by Parvin 
in the strength of from 1 to 2 per cent, with water. The irrigation is 
to be performed every twenty-four hours. 

DIABETES INSIPIDUS. 

Diabetes insipidus exists simply as a profuse urinary flow dependent 
upon some disorder of the innervation of the kidney or upon atony or 
relaxation of this organ. Its treatment consists in the use of astringents 
and tonics, and in some cases in the employment of opium or bella- 
donna, particularly if the over-secretion rests upon nervous irritability. 
Gallic acid may be used in 20-grain (1.3) powders three times a day, 
and the fluid extract or wine of ergot is often of service given in the 
dose of 30 minims to a drachm (2,0-4.0) of the former or a wine- 
glassful (32.0) of the latter. As tonics the sulphate of iron and 
strychnine are indicated. Suprarenal gland may be employed with 
advantage in some cases. 

DIABETES MELLITUS. 

In the treatment of this affection it should be remembered that it 
is the result of disordered function, and is not a disease in itself, but 
a symptom of several disease-processes. For this reason a remedy 
which succeeds in one case may fail in another. 



586 DISEASES. 

The treatment of diabetes mellitus is both dietetic and medicinal, 
of which the more important part is the diet, since diabetes is a state 
of the body in which the system is unable to utilize properly the car- 
bohydrate portions of the food, and as a result sugar is passed out in 
the urine. Glycosuria, or the mere presence of glucose in the urine, 
is not diabetes, although if it is constant it may be the early stage of 
the disease. Manifestly, both of these states are to be treated by 
decreasing the intake of those articles which will produce glucose, 
namely, the starches, and therefore the carbohydrates are to be greatly 
cut down in all anti-diabetic diet-lists ; but changes in the diet should 
be very gradually instituted, since sudden cutting off of certain articles 
may cause marked nutritional disturbance. In a certain number of 
patients it is possible for them to make glucose out of proteid matters, 
and therefore even a total abstinence from starch does not cause the 
sugar to disappear from the urine, for sugar is made from meat food or 
from the patient's tissues. This does not occur with fats, and for 
this reason these are important articles to the diabetic. We must pre- 
scribe fat meats, and, contrary to old teaching, order rich milk instead 
of skimmed milk. The following articles should be allowed : * 

Meats of all kinds (except liver), eggs, fish, cheese, butter, and 
cream ; oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, 
butternuts, walnuts, and cocoanuts ; string-beans, beet tops, radishes, 
mushrooms, lettuce and water-cress, cauliflower, spinach, and onions. 
Celery and cucumbers may also be permitted. 

Of the foods and drinks to be avoided, we have all forms of sugar, 
all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago, 
tapioca, oatmeal, barley, carrots, beets, parsnips, pie-plant, peas and 
beans, chestnuts, and most of the fresh fruits, cider, beers, champagne, 
sweet wines, and honey. 

A useful artificial milk will be found described in Part III. 

The patient should have a diet so arranged as to give all the 
calories he needs without starch, and this may be accomplished if he 
takfcs daily 2 ounces (60 grams) of butter, 2 eggs, 1\ drachms (10 
grams) of olive oil, 1 ounce (30.0) of fat cheese, 1 quart (1000 cc.) 
of milk, and 1 ounce (30.0) of alcohol. This will give the man 1600 
calories, and he needs but approximately 2400, which can be obtained 
by additional food. 

The treatment of diabetes by drugs is varied by the condition of 
the patient, the cause of his disease, and the quantity of sugar in the 
urine. While the drugs most commonly employed are used in many 
instances without any knowledge of how they act, and have each of 
them a set of warm supporters among prominent authorities, much of 
the treatment must depend upon whether or not a rheumatic or gouty 
taint is the cause of the trouble, or whether it is due to high living, 
and little exercise, producing a plethoric, congested, overloaded system. 
In the 6rst class of cases iodide of potassium and the salicylates will be 
mosl serviceable; in the second class, a restricted diet, moderate exer- 

1 h ie worthy of note that certain persons having a slight glycosuria without serious 
injury, waste under a limited diet, and require ordinary tare to support the body plus 
the diabetic drain. 



DIABETES MELLITUS. 587 

cise, and purgation to relieve engorgement of the hepatic and gastric 
veins may be needed. In the cases of gouty diabetes, where relief 
does not follow the use of the iodides and colchicum, resort must be 
had to arsenic and lithium citrate or carbonate, a combination pecu- 
liarly adapted to such a condition, according to several authorities. 
Indeed, arsenic is a sheet-anchor with many practitioners in all forms 
of diabetes, and should be given in fairly large, constantly-repeated 
doses for a long time. A very much larger body of medical men rely 
on opium or one of its alkaloids, such as morphine or codeine. The 
former is used in the dose of -J to -^ grain (0.015-0.3) three times a 
day; the latter, 1 to 5 grains (0.05-0.25) three times a day, and the 
writer has found them very useful. The morphine is by far the most 
powerful for good. Patients who are diabetic must take large ascend- 
ing doses of opiates, which they bear very well. (See article on 
Opium.) The chloride of gold and sodium (^ grain [0.006]) has 
been highly recommended by Bartholow, and ergot by Wood and 
Da Costa. In cases depending upon rheumatism the use of salicylic 
acid is often of great value, the dose being 10 to 15 grains (0.65-1.0) 
three times a day. 

In cases of diabetes in which diet will control the disease the best 
clinicians insist that drugs should be avoided, for when opium or any 
of its alkaloids are used it is necessary to give rapidly-increasing 
doses, which finally become enormous, as much as 7 grains (0.6) of 
morphine a day being taken by some persons. Once having begun 
the use of drugs in severe cases, it is very dangerous to stop them, 
for clinical experience has shown that many of these patients waste 
rapidly and generally break down when this is done. In regard to 
the time of day at which to give the morphine or codeine, they are gen- 
erally given about one hour after meals. Under these circumstances 
the drugs seem to decrease diuresis more than if the dose precedes the 
meal ; further than this, the stomach is not disordered. In some 
cases results will be obtained from opium when its individual alka- 
loids fail. Careful observation of the patient should be carried out 
to determine the proper beginning and subsequent doses, and if at 
first the opiates fail to give relief discouragement should not be felt. 

Jambul is a remedy which has been widely used by clinicians for 
the relief of diabetes with such varying results that its position in 
therapeutics is uncertain. This is probably because it is effective in 
one form of diabetes and not in another, and we are unable to make 
the clinical distinction. Jambul is used in powder or the powder is 
placed in capsules or pills. The dose is 5 to 30 grains (0.3-2.0) once 
to thrice daily, and gradually increased. As much as an ounce (32.0) 
has been given in twenty-four hours. This medicament is said to be 
advantageously combined with a pure meat diet in diabetic cases. 

The excessive thirst of diabetes can be best allayed by the use 
of acidulated water or alkaline waters containing non-purgative salts. 
It is useless to cut off the water-supply, to the production of great 
suffering, but the patient should use moderation in drinking so far as 
possible. 

The wasting coming on in diabetes is to be treated by careful 



588 DISEASES. 

diet, rest, and the supply of all the food which the patient can 
digest. In many instances the amount of aliment ingested is extra- 
ordinarily large, while in others digestion is so impaired that food 
cannot be taken. 

If cachexia comes on, iron, strychnine, bitter tonics, and the lacto- 
phosphates of lime and sodium are to be used to support the circulatory 
and nervous systems. Tea and coffee and all forms of food needing 
sweetening may be rendered palatable by the use of saccharin or of 
glycerin. The former passes through the body unchanged ; the latter 
increases the glycogen in the liver, but checks the formation of sugar 
(Ransom). 

Unfortunately, we have no positive knowledge as to the minute 
and innermost causes of diabetes, and in consequence cannot ex- 
plain the manner in which opium, codeine, or other drugs produce 
relief. 

Diabetic coma is a most dangerous complication of this disease, 
and should be treated as actively as our knowledge of its cause per- 
mits. It is thought by some that the symptoms are entirely dependent 
upon the presence in the blood of oxybutyric acid, and that hypo- 
dermoclysis or the intravenous injection of normal saline solution 
(7 : 1000) should be resorted to. Stadelman insists upon the employ- 
ment intravenously of 150 cc. of normal salt solution to which 7.2 
gm. of sodium carbonate and 4.6 gm. of sodium bicarbonate have 
been added. The injection is continued until the urine is alkaline. 
Unfortunately, the statistics of this method of treatment are not good 
so far as permanent recovery is concerned, but some form of transfusion 
should be used. (See Transfusion.) As the condition is a typical 
toxaemia, a full dose of sulphate of magnesium or sulphate of sodium 
should be given, to aid elimination by the bowels. Hypodermic 
injections of ether should be resorted to to support the heart. 

In severe cases of diabetes in which coma is feared because of a 
sudden decrease of the sugar in the urine or in which mild premoni- 
tory drowsiness is present, bicarbonate of sodium should be given in 
full doses, as much as ^ to 1 ounce (15.0-30.0) a day. This treat- 
ment should be instituted whenever the urine gives the characteristic 
reaction for acetone with perchloride of iron. 

DIARRHCEA AND DYSENTERY. 1 

Diarrhoea is a term loosely applied, perfectly correctly, to all forms 
of intestinal disturbance accompanied by the passage of liquid stools, 
and its meaning, "to run through," expresses the state it repre- 
sents. 

The treatment of each form of diarrhoea depends upon its cause, 
and no case can be intelligently treated in which the physician fails 
to recognize this aspect of the case. Diarrhoea is but a symptom, noi; 
a disease, and must be regarded solely as an evidence of intestinal 
disorder. 

1 The articles on Cholera, ("holer:! Morhus, and Cholera Infantum should be care- 
fully read in connection with this article. 



DIARRHCEA AND DYSENTERY. 589 

"While the same drugs are prescribed in many forms of the trouble, 
we may divide cases of diarrhoea into four classes, as follows : (a) 
Those in which the laxity is due to a catarrh, acute or chronic, of 
the intestinal mucous membranes, causing the passages to contain 
mucus ; (b) those where, owing to disordered innervation, a profuse 
outpouring of liquid takes place from the blood-vessels into the 
intestinal lumen ; (c) those in which, owing to disease, the glands 
fail to prepare juices to digest the food properly ; and, finally (d) those 
cases where ulceration causes irritation and bloody purging. 

The treatment of the catarrhal form first named consists primarily 
in the regulation of the diet, which should be made up chiefly of milk, 
boiled or predigested, or of milk whey, and in the administration of 
castor oil or other mild purge, such as sulphate of magnesium, to 
sweep out fermenting food and mucus. Enough laudanum should 
accompany this oil to prevent griping, and it is well to add bicarbon- 
ate of sodium, grains 20 to 30 (1.3—2.0) to the dose, both to aid the 
action of the oil and to render the bowel alkaline in reaction (normal) 
instead of acid, as caused by the fermentation abnormally present. 
A mustard plaster or* other counter-irritant should be applied to the 
abdomen. Often in the milder forms of mucous diarrhoea this is all 
that is needed, but more frequently it must be followed by the use of 
tonics and astringents, such as nitrate of silver and hyoscyamus, in 
the following pill: 

R. — Argenti nitratis gr. ij (0.1). 

Extract, hyoscyami gr. v (0.3). — M. 



Ft. in pil. No. x 
S. — One three times a day. 



Or, 



R. — Plumbi acetatis gr. ij (0.1). 

Extract, opii gr. ij (0.1). — M. 

Ft. in pil. No. x. 
S. — One three times a day. 

If these stop the diarrhoea, yet there still seems to be a tendency 
for it to return or atony is present, we should use a pill containing 
the extract of chiretta or employ nitromuriatic acid, or, better still, 
dilute nitric acid and compound tincture of cardamoms, because the con- 
stant tendency to relapse indicates a deficient secretive action on the part 
of the intestinal glands, which these remedies are prone to improve : 

R.— Acid, nitric, dil f^j.(4.0\ 

Tr. cardamomi comp fjij (64.0). 

Tr. gentian, comp fgij (64.0).— M. 

S— Dessertspoonful (8.0) every four hours. 

If the catarrhal state is persistent, no remedy compares to the 
chloride of ammonium, dose 5 grains (0.3) every four hours in liquorice 
and water. Where the catarrhal state is exceedingly chronic and 
obstinate it is well to employ 3- to 5-grain (0.15-0.3) doses of potas- 
sium iodide. In many cases where the condition of mucous diarrhoea 
becomes chronic it is necessary to resort to enteroclysis (Part III.) 



590 DISEASES. 

and the treatment needed in cases of chronic intestinal catarrh. (See 
Diarrhoea, Chronic.) 

In the second form of diarrhoea named — that in which serous or 
watery purging is present — the treatment is radically different. In 
these cases the blood-vessels of the gut are relaxed and leaking, and 
must be contracted and made water-tight. This dilatation may result 
from fear ("nervous diarrhoea"), from exposure to cold, or from 
exhaustion, extreme heat, and irritant food. If from irritant foods, 
they are generally swept out in the first flush of liquid. 

The measures to be adopted consist in those directed to the con- 
traction of the dilated and relaxed blood-vessels and the restoration 
of the proper nerve-supply to the parts. 

As the splanchnic nerves are the vasomotor nerves of the intestine 
as well as the inhibitory nerves of peristalsis, it is evident that we 
must use drugs which will cause stimulation of these fibres, and the 
chief of these is found to be opium, which diminishes intestinal peri- 
stalsis and secretion by just such an influence. In the same way 
small doses of volatile oils are of service, and camphor and spirit of 
chloroform may be used. As there is relaxation, astringents are indi- 
cated ; and as sulphuric acid is not only astringent, but is eliminated 
by the lower bowel, it is peculiarly serviceable. We find, therefore, that 
the following prescription fulfils every indication : 

K .— Acid, sulph. aromat ff ss (16.0). 

Olei cajuputi gtt. xl (2.65). 

Ext. hsematoxyri fl f^ij (8.0). 

Spt. chloroformi f£j (4.0). 

Syr. zingiberis q. s. ad f^iij (90.0). — M. 

S. — Teaspoonful (4.0) in water every two or three hours. 

If desired, kino or catechu may be used in lieu of the haematoxylon, 
or the oil of cloves substituted for that of cajuput. Camphor or pare- 
goric may also supplant these drugs. 

If the pills already named do not control the diarrhoea, and the 
discharges are so profuse as to weaken the patient very greatly, the 
following prescription may be used to check the movements, but not 
to stop them completely : 

R. — Acid, sulph. aromat f-5Jss (6.0). 

Spt. chloroformi fzij (8.0). 

Tr. opii camphorat f^ij (60.0). 

Syr. zingiberis q. s. ad fijiv (120.0). — M. 

S. — Dessertspoonful (8.0) in water every two hours. 

Or, 

R.— Tr. kino fgj (30.0). 

Tr. catechu comp f%) (30.0). 

Misturae cretse f.^iij (90.0.) 

Aquae cmnamomi q. s. adf^vj (180.0). — M. 

S. — Shake well before using. Tablespoonful (15.0) every three hours. 

In some instances these attacks appear to depend upon hepatic 
disorder, and the only cure, aside from partial relief, is to be obtained 
by the use of 2 to (5 grains (0.1— 0.-55) of mercury with chalk (hydrar- 
gyrum cum creta) or calomel, given in ', to },- grain (0.01-0.03) doses. 
Whal is said of* intestinal disorder from lack of secretion under the 



DIARRHCEA AND DYSENTERY. 591 

heading of Cholera Infantum applies very forcibly to these cases, and 
diarrhoea may persist for weeks, or only temporarily be held in check 
by the most powerful drugs, until the physician thoroughly flushes the 
intestine with bile by the use of calomel. 

Wood has highly recommended the use of a bismuth powder con- 
taining a minim or two of carbolic acid. 

For the purpose of establishing intestinal antisepsis, carbolic acid 
may be used, and naphthalin, thymol, and other drugs of this class 
have been employed, particularly salicylic acid. None of these com- 
pare with carbolic acid, however, which should be used in 1 minim 
(0.05) doses on bismuth or in water. When the carbolic acid is given 
to a child, it is best prescribed in such a way that in each teaspoonful 
a half-minim is present. This teaspoonful of liquid should be placed 
in a tablespoonful of water. In other cases sulphocarbolate of zinc 
in the dose of from 1 to 4 grains (0.05-0.2) in powder or capsule is 
beneficial. Salol combined with chalk mixture may also be advan- 
tageously used. (See prescriptions under Salol.) Eudoxine, one of 
the new bismuth salts, is also of value. It is doubtful if real intes- 
tinal antisepsis can be produced by drugs ; and if it can, they probably 
destroy useful benign organisms as well as those which are malignant. 

The regulation of the diet, which should consist in sterilized milk 
or koumyss, the former being predigested, is of the greatest import- 
ance. Should the patient be a bottle-fed baby, the proportions of the 
milk, water, and cream placed in the bottle should be varied until a 
mixture is formed which is exactly fitted to the digestion of the case. 

The after-treatment consists in the use of tonics and a carefully reg- 
ulated diet, which should be largely composed of milk and milk foods. 

The third class of cases consists chiefly of children who pass foetid, 
"mousy " smelling stools in summer diarrhoea, with green, spinach-like 
masses of semi-digested food or distinct lientery. These cases may be due 
to deficient glandular action in any part of the alimentary canal, and 
are often cured by the use of pepsin and hydrochloric acid to aid the 
gastric processes. In other instances the duodenum is at fault, and 
should be stimulated by small doses of nitromuriatic acid, or by podo- 
phyllin in the dose of fa to fa of a grain (0.001-0.0015), with a little 
milk-sugar, or given in alcoholic solution. Similarly, ipecac in pow- 
dered form may be used in the dose of \ to \ a grain (0.015-0.03) 
three times a day. In the case of children who are sufferers from 
rickets, phosphate of sodium, lime salts, and common salt should be 
freely given. (See Cholera Infantum.) 

The fourth type, generally known as dysentery, is due in nearly 
all cases to the micro-organism of Shiga associated in some cases 
with hepatic trouble, in others to the drinking of impure water, 
and in the third place to exposure to heat or cold and the use of bad 
food. It is in most cases a very obstinate form of diarrhoea, requiring 
much skill and patience for its cure. In the chronic forms deep 
ulcers may exist; even in the milder cases a high inflammation is 
often present. 

In those cases which are due to exposure o heat and hepatic 
trouble there are three remedies which are far above all others in value 



592 DISEASES. 

and should always be resorted to. The first of these is sulphate of 
magnesium with sulphuric acid ; the second is calomel ; the third 
ipecac. 

The magnesium should be used in a special manner to be effective 
(see Magnesium Sulphate), and the calomel should be used in full 
purgative amounts, but is contraindicated if much weakness is present. 

The third remedy never to be forgotten is ipecac. (See Ipecac- 
uanha.) 

If the passages are slimy and bloody, -^-q of a grain (0.0003) of 
bichloride of mercury every hour or two is of service, and if much 
blood is present high rectal injections of the distilled extract of hama- 
melis and water half and half are of value. In some forms of dys- 
entery due to acute inflammation large enemata of iced water are of 
the greatest value. The water should be ice-cold, and at least a quart 
injected by hydrostatic pressure. This method can only be used in 
strong persons, and is very useful in that it also aids in reducing any 
fever which may be present. The following mixture may be injected 
into the bowel in place of cold water in feeble cases : 

R.— Sodii boratis • • • • 3J ( 4 - )- 

Tinct. benzoin f£j (4.0). 

Spt. camphorse fgj (30.0). 

Aquas ferventis Oij (1 litre). — M. 

If the ulcers are very old and chronic, nitrate-of-silver injections 
of the strength of 10 to 20 grains (0.65-1.3) to the pint (500 cc.) of 
water may be employed in large bulk, a salt solution being at hand 
for the destruction of the silver salt if the local action which ensues is 
too severe. 

Recently the injection of water or medicaments into the bowel for 
the purpose of influencing the intestinal wall has given way in the 
hands of prominent physicians to irrigation by means of an inlet and 
outlet tube. The inlet tube should be attached to a fountain syringe, 
and the outlet tube be long enough to reach to a vessel by the side of 
the bed and of sufficient calibre to carry off flaky mucus. In many 
cases of dysentery of a mild form rectal irrigation will suffice, but if 
the entire colon is involved higher injections are necessary. The 
irrigation should be continued until the returning fluid becomes 
perfectly clean and free from foreign particles. If the bowel move- 
ments are very frequent, the injections may be made every three 
hours. Probably the best solution to employ for irrigation where 
much mucus and pus is present is one composed of bichloride of 
mercury, 1 : 5000. When this is used, a pure water injection or one 
of 1 : 30,000 should follow it, in order to prevent absorption of the 
mercury into the system. If for any reason the effect of the bichlor- 
ide is feared, boric acid may be used in the proportion of 1 drachm 
(4.0) to the pint (500 cc), or 15 grains (1.0) of sulphocarbolate of 
zinc iiddcd to 1 quart (1 litre) of hot water be injected. If the dys- 
entery is due to the amoeba coli large rectal injections of a solution 
of quinine in the proportion of 1 to 3000 should be used, as this drug 
destroys thai organism. (See Enteroclysis, in Part III.) 

Tannic acid is an intestinal antiseptic, and can be employed in 



DIARRHCEA, CHRONIC. 593 

the strength of 1 drachm to the pint (4.0 : 500 cc.) for irrigation 
purposes. 

DIAHRHCBA (CHRONIC). 1 

This is one of the most obstinate conditions which the physician 
is called upon to treat. It may be due to nervous irritability of the 
bowels, so that the entrance of food or drink sets up an excessive 
peristalsis which so hurries the food and drink through the alimentary 
canal that digestion and absorption are only partly performed. Chronic 
diarrhoea may also be due to chronic intestinal catarrh, to ulcerations 
of the small or large intestine, as after typhoid fever, or to rectal dis- 
ease, which reflexly causes hyperperistalsis. Fissure of the anus often 
causes persistent diarrhoea by reflex irritation. In those cases due to 
hyperperistalsis an advantage is often gained by directing the patient 
to take as little liquid as possible, particularly at meals, and to avoid 
coffee or other stimulants to reflex activity. Highly-seasoned foods 
are also to be avoided. Meats should be preferred to vegetables, and 
an absolute diet of peptonized milk may be ordered, the milk being 
given in tablespoonfuls every few minutes, rather than in large amounts, 
or at meal-times if the patient will remain in bed. Counter-irritation, 
constant and as severe as the patient can stand, should be used over 
the abdomen. Suppositories and rectal injections seldom benefit this 
class of cases, but a pill composed as follows may be useful : 

R. — Argent, nitratis gr. iv (0.2). 

Ext. hyoscyami gr. x vel xxx (0.55-2.0). 

Ext. opii gr. ij vel iv (0.1-0.2).— M. 

Ft. in pil. No. xx. 
S. — One pill one hour before each meal. 

In other instances some of the astringent prescriptions given under 
the article on Diarrhoea are better than the above. In the cases due 
to ulcers of the rectum injections of nitrate of silver 2 grains to the 
ounce (0.1 : 30.0) are of value, particularly if followed by a 5- or 10- 
grain iodoform suppository. Operative procedure against anal fissure 
will often cure a diarrhoea due to this cause. The cases due to intes- 
tinal catarrh are benefited by the use of full doses (5 to 20 grains 
[0.3-1.3]) of bicarbonate of sodium by the mouth and the use of 
iodoform suppositories, which not only relieve the rectal irritation 
nearly always present, but exercise the peculiar effects of iodine upon 
the catarrhal process. In cases of so-called morning diarrhoea absti- 
nence from liquids before going to bed the night before and a very 
dry and small breakfast are to be strongly recommended, with rest in 
bed during the morning hours. 

Rockbridge Alum water, which contains iron and alum, is useful 
in cases of diarrhoea with anaemia. 

1 Read with this article those on Diarrhoea and Dysentery and Enteroclysis. 

38 



594 DISEASES. 



DIPHTHERIA AND MEMBRANOUS CROUP. 

Diphtheria is at first a distinctly local disease, the membrane in the 
upper air-passages forming a nidus from which the entire body ulti- 
mately becomes poisoned by the micro-organism peculiar to the malady. 
While it is true that in some cases of membranous pharyngitis or 
laryngitis the true Klebs-Loeffler bacillus cannot be found, it is a fact 
that all cases should be treated as if they are true diphtheria, since 
in this way much good can be done, and no harm follows if the malady 
fails to develop. 

The best local application to the throat is peroxide of hydrogen. 
A cotton swab should be soaked with the undiluted 10- or 15-volume 
solution and pressed against the mucous membrane which is diseased ; 
or, if this cannot be done, a spray, from a glass atomizer, of the 
strength of 1 : 4 of water may be employed. The effect is often 
extraordinary. After a few applications the false membrane appears 
to exist only in disorganized shreds. If the nasal chambers become 
affected, a tepid solution of ordinary salt (7 : 1000) should be used in 
a spray or by means of a fountain syringe. The child is placed with 
its hips on the lap of one nurse and its head on the lap between the 
knees of another, the dress of the nurse being protected by a rubber 
sheet, and the nasal cavities irrigated. The position of the child 
should be on its side, not on its back, and the face should be turned 
down sufficiently to allow the liquid, after entering the upper nostril, 
to flow out the lower one with ease, the child breathing through its 
mouth. The applications should be made as frequently as the mem- 
brane forms. 

Antitoxin Treatment. — This treatment supplants all others in effi- 
cacy and usefulness, and should displace all other plans of treatment 
except the local applications when antitoxin can be had. Of all the 
extraordinary advances made in pathology and therapeutics, the intro- 
duction and proof of the value of antitoxin in cases of diphtheria is 
perhaps most worthy of note. (For the study of Antitoxin itself, see 
Antitoxin in Part III.) 

There are several facts in connection with the use of the diphtheritic 
antitoxin which should be borne in mind. The syringe for injecting it 
should have a glass barrel in order that any foreign bodies or air-bubbles 
can be seen and removed before the injection is given. The packing 
of the piston should be made of asbestos or rubber, since it is practically 
impossible to sterilize leather or other packing, and the different parts 
of the syringe should be easily disjointed in order to permit thorough 
cleansing and sterilizing. Immediately before and after the use of the 
syringe the needle should be removed and the cap taken off so that the 
sterilizing fluid may readily enter the syringe and needle, and then 
thev should be placed in warm water which is brought to the boiling- 
point. I > \ this gradual heating Ave avoid the breaking of the glass 
barrel. It is best to employ one of the syringes made for the purpose 
now being described. The injection is to be given slowly during a 
period of several minutes into any part of the body which has loose 
Bubcutaneous tissues, such as the broad of the back, the side of the 



PLATE IV. 







% t 






^•WPH^ 




Showing the Effect of Antitoxin on the Local Diphtheritic 
Process. The Figures on the Left Show the Gradual Increase of 
the False Membrane from the First to the Thirty-sixth Hour. 
The Figures on the Right Show the Disappearance of the Mem- 
brane During the Nex1 Thirty-six Hours as a Result of the 
Use of A i it jiox 1 1 1. 



DIPHTHERIA AND MEMBRANOUS CROUP. 595 

abdomen, or the outside of the thigh. The skin at the place of 
injection should be thoroughly sterilized beforehand, and after the 
injection the fluid should be allowed to diffuse itself and not be spread 
by rubbing. 

The following are the recommendations as to the manner of using 
diphtheria antitoxin made by the American Pediatric Society : 

" Dosage. — For a child over two years old the dosage of antitoxin 
should be, in all laryngeal cases with stenosis and in all other severe 
cases, 1500 to 2000 units for the first injection, to be repeated in from 
eighteen to twenty-four hours if there is no improvement ; a third dose 
after a similar interval if necessary. For severe cases in children under 
two years, and for mild cases over that age, the initial dose should be 
1000 units, to be repeated as above if necessary ; a second dose is not 
usually required. The dosage should always be estimated in antitoxin 
units, and not in the amount of serum. 

" Quality of Antitoxin. — The most concentrated strength of an ab- 
solutely reliable preparation. 

" Time of Administration. — Antitoxin should be administered as 
early as possible on a clinical diagnosis, not waiting for a bacteriological 
culture. However late the first observation is made, an injection 
should be given unless the progress of the case is favorable and satis- 
factory." 

The dose of antitoxin serum is to be judged by its known strength 
or power of conferring immunity and by the severity of the disease and 
the susceptibility of the patient. At present the bulk of the ordinary 
antitoxin serum of Parke, Davis & Co. is 1 to 5 cubic centimetres to 
each dose of from 500 to 2000 units. Small doses are not required 
by little children. The fact that they are more easily killed by the 
disease than older children makes a large dose necessary. 

It has been urged against serums containing over 250 units per 
c.cm. that their use is apt to be followed by untoward effects such as 
skin eruptions and local irritations. On the other hand, if the weaker 
serums are employed such large amounts have to be given that very 
considerable swelling of the area in which the injection is given is pro- 
duced, and of course a large amount ot valuable time is lost before 
the whole dose is absorbed ; whereas if serums containing high immu- 
nizing power are employed the small dose is quickly absorbed. In 
pressing cases of nasal or laryngeal diphtheria the stronger serums 
are indicated, whereas in the more moderate cases the lower grades of 
strength may be used. 

The general trend of professional opinion the world over is strongly 
in favor of the use of antitoxin in diphtheria. So far there have been 
published an immense number of reports and statistics concerning its 
use, and it is an undisputed fact that the use of antitoxin is of the 
greatest value. Whereas the average death-rate without antitoxin 
varies from 25 to 65 per cent, according to the severity of the epi- 
demic, with the antitoxin it falls as low as 16 or even 8 per cent. 

Much depends upon the early use of the remedy, for after degen- 
erative changes have taken place in the heart and kidneys the damage 
is done. Statistics show that in cases which receive the antitoxin on 



596 DISEASES. 

the first day the mortality is often only 3 to 5 per cent., whereas with 
each advancing day of delay the percentage rises, so that when it is 
not given till the fourth it is as high as 40 per cent. As the injection 
of antitoxin does no harm, it should be used in all doubtful cases of 
diphtheria without waiting for a bacteriological diagnosis. The dose 
should be repeated every six or twelve hours in severe cases, and 
doubled in amount in very malignant cases or in those with deeply 
seated cervical induration or laryngeal or nasal diphtheria. 

When the antitoxin is given general improvement usually takes 
place in twenty-four to forty-eight hours, and the temperature falls. 
The spread of the membrane is arrested and its separation soon begins. 

The author cannot too strongly urge upon the reader the vital im- 
portance of using antitoxic serum early and freely. The reports in 
which it has been condemned are imperfect and unreliable. It has 
been claimed by some persons that since the use of antitoxin we meet 
with more cases of complications or sequelae than ever before. The 
reason is manifest, viz., that before antitoxin was used all the very 
malignant cases died, whereas a large percentage of these are now 
saved, and suffer from lesions which if antitoxin had not been used 
would have been fatal. Every patient who apparently suffers from 
the disease should receive this remedy, so potent for good and so lack- 
ing in harmful qualities even when given to non-diphtheritic persons. 
The physician who can obtain the serum and does not use it is not 
doing the best thing for his patient. 

Although the use of antitoxin for immunizing purposes where per- 
sons have been exposed to infection has been resorted to, it is not 
practised by the general body of the profession to the extent that it 
should be. The use of 500 normal antitoxin units will usually pro- 
duce immunity for three or four weeks. 

Full doses of antitoxin of the higher potencies sometimes give rise 
to pains in the joints or to an erythematous eruption, which are 
without danger and need not excite alarm. 

The only new local application which promises much is that of 
Loeffler. He directs that the mucous membrane shall be carefully 
wiped off by a pledget of cotton, and after this is done that a second 
pledget dipped in the following solution shall be pressed against the 
diseased area for ten seconds at three-hour intervals: Menthol 2J 
drachms (10 grammes) dissolved in 9 drachms (36 cc.) of toluol, to 
which is added 1 drachm (4 cc.) of liquor ferri chloridi and abso- 
lute alcohol 2 ounces (60 cc). This solution, if kept in a dark 
glass bottle, well stoppered, will last for months. The author prefers 
to use peroxide of hydrogen in all cases, as it is very efficacious and 
painless, whereas the application of Loeffler's solution is apt to be very 
painful. 

The local use of iodine, carbolic acid, and similar irritating and 
poisonous substances is not justifiable. 

Great care as to the prevention of the disease is needful. All cases 
should be carefully isolated; children whn have been exposed should 
be quarantined for fourteen days; persons in perfect health who have 
Ixcn aursing such patients should also be quarantined, for in the 



DIPHTHERIA AND MEMBRANOUS CROUP. 597 

secretions of the throat diphtheria bacilli may be carried by an appar- 
ently healthy nurse to another patient. The nurse and physician 
should therefore gargle with saline solutions and follow this by anti- 
septic mouth washes, using the greatest cleanliness as to the hair, 
hands, face, and clothing. 

The maintenance of the patient's strength during an attack of 
diphtheria is of great importance. Simple, easily swallowed, and 
easily digested food should be freely given, and plenty of water 
provided to allay thirst and flush the kidneys of poisons. Milk, pre- 
digested or plain, is useful, as is also properly made beef-tea (see 
Feeding the Sick) ; soft eggs, etc., are to be given ; and if swallowing 
is difficult because of soreness or paralysis, then we must feed by the 
use of the soft-rubber nasal tube, inserted through the nasal cavities 
into the pharynx after being well oiled with albolene, which has not 
a disagreeable odor. (See Gavage, Part III.) Such a method of 
feeding may be resorted to in cases of inability to swallow arising 
from paralysis and consequent regurgitation ; coughing which pre- 
vents swallowing, as in tracheotomy cases ; and in vomiting which 
sometimes follows swallowing, but often does not follow nasal feeding. 

Feeding by the rectum may also be used, and hypodermoclysis is 
not to be forgotten for the purpose of supplying fluid to the tissues. 

Mercury is very useful in full doses in diphtheria in sthenic per- 
sons, and the bichloride may be given by the mouth in doses of -^ 
grain (0.0013) every hour until the stools are loose or signs of ptyal- 
ism appear. Tincture of the chloride of iron, quinine, and strych- 
nine are of service to keep the kidneys active, to stimulate the heart 
and respiration, and to support the vital forces. The close of the 
tincture of iron may be as much as 2 minims (0.1) every hour to a 
child of four years. The food of a child during an attack of diphtheria 
should be plentiful, and consist of pancreatized and sterilized milk. 
It is best to use throat applications before giving the food, in order to 
avoid vomiting. 

Steam set free in the air of the room is very useful as an adjuvant 
to local treatment, and the bronchitis tent may be used in laryngeal 
cases. 

A method of using turpentine by inhalation was highly recommended 
by J. Lewis Smith. The. following prescription is placed in water in 
the proportion of 2 tablespoonfuls (30.0) to a quart (1 litre), and this 
mixture is then placed on a gas or oil stove in a broad, open vessel and 
allowed to boil constantly. The air of the sick-room is soon laden with 
the vapor, which is not offensive. The prescription is as follows : 

R. — Acid, carbolici "I _- « 2 . /OA AN 

Olei eucalypti } aa f & ^ ^ 

Spt. terebinthina? fgviij (240.0).— M. 

S. — Use as directed. Label : Poison if taken internally. 

In other cases there is no doubt that calomel by sublimation does 
great good. The child is placed in a bronchitis tent and from 3 to 5 
grammes of calomel are placed in a sublimator and gradually vapor- 
ized into the air the child breathes. 



598 DISEASES. 

When the glands of the neck threaten to suppurate, ice-bags should 
be applied to the throat and pieces of ice held constantly in the mouth, 
while the tincture of iron is pushed in as full amounts as possible. 

If suffocation is imminent, inhalations of oxygen are to be used 
and atropine or strychnine employed, but tracheotomy or intubation 
is usually the safer plan of treatment. 

Chlorate of potassium has been used purely empirically in the treat- 
ment of this disease, but it should never be given internally, as the 
kidneys are already overburdened, and this drug is not only useless 
when so given, but is in addition a renal irritant. Although the author 
has been criticised for this last statement, he is convinced of its truth. 

It is important in cases of diphtheria to maintain the nutrition of 
the patient to the best of our ability, for thereby we increase his vital 
resistance. Food should be liquid or semiliquid, easily digested or 
predigested. and given at regular intervals and in moderate amounts, 
so as not to upset the stomach. If milk is used, it may be accom- 
panied by pancreatin : if starchy foods are employed, we should give 
with them some taka-diastase. If the throat is too swollen to permit 
of swallowing, carefully predigested food must be given by the rectum. 
(See Peptonized Foods.) The kidneys may be kept active by the use 
of moderate hypodermoclysis in such cases. As depression is a char- 
acteristic feature of diphtheria, the possible need of stimulants is to be 
borne in mind, and of these alcohol and strychnine are the best. 

DROPSY. 

Dropsy is to be regarded as a symptom (not as a disease in itself) 
which may arise from many causes, such as cardiac, pulmonary, or 
renal diseases, or depend upon obstruction, from various causes, to the 
normal flow of the blood and lymph through the vessels and tissues. 
Its existence is dependent upon so many causes of a still more indirect 
nature that it is almost impossible to notice all of them, but the fol- 
lowing consideration of the subject will at least make clear some of 
the reasons for its occurrence and indicate the means which are to be 
taken for its relief. 

At the very start we are confronted by facts which seem para- 
doxical, but which are in reality quite reconcilable. These are, that 
low arterial pressure predisposes to dropsy, and that high venous 
pressure does likewise, or, in other words, that the cause of exudation 
on <>ue Bide of the circulation is its prevention on the other. 

The explanation of these statements lies in a thorough under- 
standing of the physics of the circulatory system and its anatomical 
structure. It will be remembered that dropsical exudation takes 
place from the capillaries, and that the integrity of the walls of the 
blood-vessels and lymphatics depends upon normal nutrition, or, in 
other words, upon a proper blood-supply. As a consequence, dropsy 
may be due to poorl y-nourished vessels as much as to any other 
cause. Further than this, a watery state of the blood permits abnor- 
mal exudation. 

The force exercised upon the column of blood as it is driven out 



DROPSY. 599 

by the heart into the aorta may be considered as the chief support of 
the capillary circulation, so that if the heart be weak the pressure 
falls in the arteries, and in consequence the rapidity of flow is 
decreased in the capillaries, while, on the other hand, an increased 
cardiac activity hastens the capillary circulation. As the arterial 
pressure and force depend not only upon the heart-force, but also 
upon the tonicity of the arteries which carry the blood-stream, it 
becomes evident that dilated arteries must lower blood-pressure even 
if the heart be strong, although practically the heart and vasomotor 
system generally fail or increase in tone together. We find, there- 
fore, that a weak heart or a relaxed arterv tends to cause stagnation 
of the blood in the capillaries, and, having found that such stagna- 
tion is productive of exudation, it is not hard to discover why low 
arterial pressure is a cause of dropsy. 

Having shown this to be true, let us turn to an explanation of the 
fact that a high pressure in the veins is productive of the same changes. 

Here the normal pressure is almost nothing, being much less than 
in the arteries, and considerably less than in the capillaries. The 
result of this is, that in health the blood flows rapidly from the high 
pressure of the artery to the low pressure of the vein, and passes 
through the small veins under a gradually decreasing pressure until 
it reaches the heart. Any obstruction to this venous flow must 
increase the venous pressure, and, the venous pressure being in- 
creased, the rapidity of flow through the capillaries must be decreased. 
The whole subject may be made more clear by the following example : 

Supposing that two iron tubes are connected at one end by several 
lines of rubber tubes (the capillaries), and that water is flowing into 
the first tube, or the artery, under a pressure which is represented by 
the figure 100, while the resistance to the flow in the second tube, 
the vein, is represented by the figure 0. It at once becomes evident 
that the rapidity of the flow through the connecting rubber tubes will 
be very great, whereas if the pressure in the first or arterial tube is 
decreased to 50, the rapidity is decreased to one-half, or if the pressure 
in the second tube be increased to 50 instead of remaining at 0, the 
same changes will occur; in either instance capillary flow is lessened 
and exudation is caused. This is a crude explanation of the pathology 
of dropsy, and, having understood it, let us proceed to discover the 
causes of dropsy in various diseases. 

In cardiac disease it is due to a weak heart being unable to supply 
the arteries with enough blood to maintain the normal pressure, or to 
a damming-up of blood in the venous system as the result of the 
imperfect emptying of the cardiac cavities. In the first instance low 
arterial pressure produces dropsy; in the second, high venous pressure 
has a similar effect. 1 

In renal troubles the dropsy depends more upon the lack of proper 
nutritive processes in the capillary walls and upon changes in the 
blood-pressure than upon other causes. If the kidney is diseased, it 
may not be able to eliminate the proper quantity of liquids, which 

1 For an explanation of these changes in the action of the muscle, valves, and car- 
diac action in heart disease, see the article on Heart Disease- 



600 DISEASES. 

accumulate and finally escape into the tissues, while the same failure 
in renal function causes disease of the blood-paths themselves, and 
often produces cardiac complications. 

Hepatic troubles cause dropsy by producing pressure upon the large 
blood-vessels going to the liver, and, in consequence, the exudation is 
generally confined to the lower limbs and abdomen. If the hepatic 
trouble be severe, some failure in the nutrition of the blood-vessels 
and changes in the quality of the blood may ensue. 

Pulmonary disease rarely causes dropsy unless the venous pressure 
is greatly increased and productive of cardiac dilatation, or, as in 
phthisis, 'where the changes in the nutrition of the body involve the 
blood-vessel walls and the blood. 

Having spoken of these causes of dropsy, it remains for us to con- 
sider its treatment, which may be divided into two parts — namely, 
that directed to its removal after the liquid is poured out, and its 
relief or cure by direct attention to its causes. The means for the 
removal of the fluid are suitable to all cases, be the cause what it may, 
unless the dropsy be of renal origin. Whenever an accumulation of 
liquid takes place in the tissues, drugs or measures must be resorted 
to which will cause the emunctories of the body to get rid of it. In 
ascites, in particular, we may employ elaterium in the dose of -J- of a 
grain (0.01), or elaterin in the dose of 2V of a grain (0.003), placed 
in the mouth and washed down by a little water, or, if this is not 
used, the compound jalap powder may be resorted to in the dose of 
20 to 30 grains (1.3-2.0), and to it may be added, to increase its 
efficiency, 10 grains (0.65) more of bitartrate of potassium than the 
official powder contains. These two remedies are particularly ser- 
viceable in renal dropsies, since the elaterium is supposed to aid in 
the elimination of urea by the bowel, while the cream of tartar in the 
jalap powder increases the action of the kidneys. 

The cream of tartar is not to be employed in cases of acute 
nephritis. 

Compound extract of colocynth may be employed in the dose of 
2 to 6 grains (0.1-0.3), according to the state and idiosyncrasy of the 
patient. 

All these remedies relieve dropsy by causing so great an outpour- 
ing of liquid from the blood-vessels of the intestine that the liquids in 
the tissues are taken up by the depleted blood-vessels to replace the 
loss through the action of the purgative. In other words, these 
purgatives render the alkalinity of the blood greater by concentra- 
tion, and absorption of fluid occurs by reason of the following physio- 
logical and physical facts : 

As is well known to every physiologist, the passage through a 
blood-vessel of a salt solution of less than -^ of 1 per cent, causes an 
abstraction of salts from the surrounding tissues by the circulating 
Quid, in order that the amount of salts in the vessels and tissues may 
be identieal. At the same time the tissues become infiltrated with 
liquid. On the other hand, if the solution be stronger than the 
normal, the liquid leaves the tissues to enter the vessels, and the 
tissues in consequence shrink. 



DROPSY. 601 

When salines are given to relieve dropsy, they must be admin- 
istered in concentrated or saturated solution and on an empty stom- 
ach, total abstinence from the drinking of water being insisted upon 
until they have fully acted, for the reasons given in the last para- 
graph. For this reason they should be given an hour or so before 
breakfast. If these directions are not followed, this method of treat- 
ment is useless. (See Magnesium Sulphate.) 

The other means which we possess for the removal of dropsy are 
by way of the kidneys and skin. If the kidneys are hopelessly dis- 
eased, that pathway is almost useless, but if they are only passive or 
partly inactive, diuretics may be used to stimulate their secreting 
structure and to increase the leakage of liquid through them by 
increasing blood-pressure. Such patients should be placed almost 
entirely on a milk diet, and many of them will greatly improve under 
the use of buttermilk to the exclusion of other nourishment. If this 
cannot be taken, sugar of milk may be employed as an active diuretic. 
(See Sugar of Milk.) 

Often the kidney will be found inactive, because, owing to conges- 
tion from cardiac trouble, it cannot act. Under these circumstances 
digitalis, in 5- or 10-minim (0.35-0.65) doses of the tincture, given 
three times a day, will be of value, and its efficacy will be increased 
by the addition of 1 minim (0.05) of the tincture of cantharides if the 
renal lesion is exceedingly chronic or mere torpidity exists. Digitalis 
and sauill, in pill form, as follows, may be used: 

R.—Pulv. digital, fol gr. xx (1.3). 

Pulv. scillse gr. xx (1.3).— M. 

Ft. in pil. No. xx. 
S. — One every five hours. 

Or digitalis and calomel may be employed in pill form in renal and car- 
diac dropsies. Apocynum cannabinum is also a useful drug in this state. 

Caffeine is also a useful diuretic, particularly in torpidity of the 
kidney, as it stimulates the secretory epithelium, thus eliminating urea 
and other effete matters, and increases the passage of liquids by the 
increased blood-pressure which it produces. 

That a large amount of liquid may be gotten rid of through the 
skin under the influence of heat is well known. (See Heat.) In 
addition to external heat we may use pilocarpine by the mouth or 
hypodermically in localized dropsies, to produce absorption and con- 
sequent elimination of liquid by sweating. No drug should ever be 
given hypodermically in dropsy of a general character, as it will not 
be absorbed from the water-soaked tissues with any rapidity, if at all. 

The chief means of relief to be resorted to in cases of ascites is tap- 
ping. Efforts to remove effusions in the peritoneal cavity by medicinal 
measures are rarely followed by success. In reality, tapping is far 
less heroic treatment than purgation, and the old theory that it is dan- 
gerous has been completely disproved. It has been found that tap- 
ping not only removes the fluid, but may in some unknown manner 
produce a permanent cure after from one to twenty or more operations. 
In performing tapping the patient is to be placed in a sitting or semi- 



602 DISEASES. 

recumbent position, and directed to evacuate his bladder, so that there 
will be no danger of this viscus being injured by the trocar. The 
skin of the abdomen in the middle line one or two inches below the 
umbilicus is next benumbed by salt and ice held against it. The 
physician then takes a trocar and canula, at least four inches long, 
and pushes it through the abdominal wall until by the decrease in 
resistance he knows its point has entered the abdominal cavity. It is 
well to have a broad abdominal bandage placed around the belly, so 
that an assistant by pulling on its ends may support the belly-walls 
when relaxed by the escape of the effusion. As a rule, not more than 
one-half or three-fourths of the liquid should be removed at one sit- 
ting, as its entire removal may be followed by collapse. The value 
of iodide of potassium in cases of ascites is not to be forgotten, but 
it must be given cautiously if renal disease is present. 

Where the tenseness of the skin in the lower extremities causes 
danger of local sloughs, some authors recommend small incisions for 
the escape of the liquid, the limbs being encased in sterilized absorb- 
ent cotton to absorb the liquid. (See Acupuncture.) 

DYSENTERY. 
(See DlARRHCEA.) 



DYSMENORRHEA. 

The existence of dysmenorrhoea depends upon so many conditions 
that the treatment employed in one case is seldom productive of suc- 
cess in the next. This is not the place for a consideration of the 
surgical measures adopted for the cure of this symptom, and only the 
medical treatment will be spoken of. 

When dysmenorrhoea results from the taking of a cold, and is 
accompanied by uterine congestion and irritability, the following 
measures are particularly valuable, and may do good in many cases 
depending upon other causes : The patient should take a hot sitz- 
bath, and immediately get into bed as soon as the buttocks are dried, 
being well covered while in the tub and afterward by a blanket. A 
turpentine stupe is now to be used (see Turpentine), and 10 grains 
(0.65) of Dover's powder to be administered, unless some idiosyncrasy 
toward opium is known to exist, when a half or a fourth of this 
amount may be employed. Often when the attack is accompanied by 
constipation a purgative dose of Epsom salts or aloes is of service in 
the congestive forms of the disorder. 

If the pain is persistent and severe, a belladonna suppository, of 
J grain of the extract, may be inserted into the rectum, or in other 
cases belladonna ointment smeared over the os uteri will be found of 
service, The latter method is generally impracticable and is rarely 
resorted to. Very commonly belladonna tincture, by the mouth, is of 
service in relaxing the spasm of the cervix and of the uterine fundus. 

Some practitioners resort to the use of opium at each epoch, and 



DYSPEPSIA— DYSPNCEA. 603 

keep the patient partially narcotized until menstruation is passed. 
This is unjustifiable and born of ignorance and bad practice, since 
the physician is simply dodging the trouble and predisposing the 
patient to future attacks by reason of the constipation and the result- 
ing habit which is almost sure to appear after the repeated employ- 
ment of opiates. 

When the dysmenorrhoea is due to obstruction of the cervical canal 
by organic changes or flexions, these conditions must, of course, be 
relieved before a cure can be expected, and the medical treatment 
can be directed only to the alleviation of the pain. Divulsions or slow 
or rapid cervical dilatation should be carried out by the use of instru- 
ments or tents. 

In neuralgic dysmenorrhoea, dependent rather upon nervous dis: 
order accompanying menstruation than upon menstruation itself, 
measures directed to the improvement of the nervous system and the 
nutrition of the patient are necessary. (See Cimicifuga.) These cases 
generally occur in nervous, anaemic women run down by excessive 
dancing or other gayety or by the bearing and care of a large family 
of children. 

A course of strychnine or quinine and iron in small doses is often 
beneficial in these cases, and horseback exercise between the men- 
strual periods, out-of-door life, and avoidance of excessive dancing 
and exhausting exercise are to be ordered. 

Sometimes bathing the loins with alternate dashes of hot and cold 
water may do good in atonic patients. 

Cannabis indica and gelsemium are often of great service, both as 
cures and alleviators of the pain, and antipyrin, acetanilid, and 
similar drugs may be resorted to while the attack lasts, if it be 
neuralgic. 

When the pain seems to be greater than the patient can bear, 
enough ether or bromide of ethyl should be given by the physician, by 
means of inhalation, to produce the primary stages of anaesthesia, but 
chloroform is not advisable, as the patient, if taught its value by the 
doctor, may resort to this dangerous drug without advice and die from 
an overdose. 

DYSPEPSIA. 

(See Indigestion.) 

DYSPNCEA. 

Shortness of breath, or dyspnoea, arises from asthma, cardiac weak- 
ness, abnormal innervation resulting in cardiac palpitation, from the 
accumulation of fluids in the chest, from the involvement of the lungs 
by any disease-process in such a way that respiration becomes im- 
paired, or it is produced by indigestion, or, finally, by the encroach- 
ment on the lungs or chest-walls of tumors and growths. It may also 
be due to uraemic or diabetic toxaemia. 



604 DISEASES. 

Each of these states must be removed to effect a cure, but it is only 
of the relief of the symptoms that we will speak. 

In old persons who suffer from dyspnoea the result of bronchor- 
rhoea. where a large amount of liquid fills the bronchial tubes and 
shortness of breath follows exertion, strychnine is the best remedy 
that we have. Its value depends upon its powerful influence over 
the respiratory centres, on which it acts as a stimulant ; and as these 
cases very commonly also have dilatation of the right side of the 
heart, with consequent cardiac enfeeblement, strychnine is of addi- 
tional service through its influence upon the circulation. These per- 
sons are not to be given opium or its alkaloids or any sedative drugs, 
as such medicines, while giving temporary relief from cough, only 
serve to depress the respiratory apparatus and cause an accumulation 
of liquid mucus in the chest as a result of the prevention of cough 
and lack of expectoration. The cases in which opium or morphine 
do good are those in which, through nervousness or functional nervous 
disorder, the respiratory cycle is imperfect, and, above all, in those 
instances where dyspnoea occurs as the result of cardiac disease. In 
these cases the attacks of oppression and suffocation can often be 
entirely set aside by the use of J to J grain (0.008-0.015) of mor- 
phine, given every night or at night and morning. If these doses fail, 
larger ones may be cautiously used. Hyoscine, instead of causing 
sleep, nearly always makes these cases worse. 

Sometimes a little carbonate of ammonium is useful as a respira- 
tory and cardiac stimulant in cases of dyspnoea. 

Dry cupping applied over the back of the chest may also be ser- 
viceable when shortness of breath from cardiac or pulmonary trouble 
is present. 

In cases of dyspnoea due to emphysema and pulmonary inflamma- 
tion of a chronic type, or in those persons who take cold on the 
slightest exposure, particularly after attacks of asthma, arsenic is 
useful if continuously employed. 

If pleural effusion be present, relief of a positive and lasting nature 
can only be obtained through aspiration, or, in other words, by the 
operation known as thoracentesis. 

EARACHE. 

Earache may arise from a great number of causes, all of which 
are, practically speaking, inflammatory. The pain may be the result 
of acute or chronic inflammation of the middle ear, with a serous or 
purulent exudate, or to furunculosis of the external auditory canal. 
In other cases an eczema of this part is very painful. The treatment 
of an acute earache is systemic and local, the former being based on 
tin- genera] rules governing the management of inflammatory processes, 
the latter by the urea involved and the cause of the trouble. In the 
genera] treatment several leeches may be placed in front of or behind 
the ear, and heat in a dry form is to be applied to the head on the 
Bide affected, by means of a hot bottle or water-bag. Poultices, oil and 
laudanum, and similar applications are not to be resorted to, as they 



EARACHE. 



605 



may ultimately cause trouble and do not always produce even tempo- 
rary relief, but tincture of belladonna and tincture of opium in equal 
parts may be dropped in the ear in the dose of 5 to 10 minims when 
necessary. 

A very efficient means of relieving the pain is to irrigate the ear by 
means of a fountain syringe with a 

normal salt solution, used as hot as Fig. 103. 

can be borne, every hour or two. 

Cardiac sedatives are indicated, but 
quinine is distinctly contraindicated, 
as it tends to cause aural congestion. 

If a cold in the head is present, 
and with it acute myringitis, it is im- 
portant to establish a free opening 
through the nostrils, particularly if 
the middle ear is also involved, in 
order to clear the orifice of the Eus- 
tachian tube. This is to be accom- 
plished by dropping into each nostril 
some adrenalin chloride (1 : 5000 solu- 
tion) or 1 to 3 minims (0.05-0.15) 

of a 4 per cent, solution of COCaine, Aural irrigator. 

and, as soon as the engorged mucous 

membrane is anaesthetic and shrunken, to use an atomizer with a fine 

spray attachment and the following solution : 




R. — Acid, boric. . 

Sodii chlorid. 

Sodii borat. . 

Aq. rosse . . 
-Use as a spray. 



gr. x (0.65). 

gr. xij (0.8). 

gr. x (0.65). 

. . q. s. ad fgiij (90.0).— M. 



This should be followed by a spray of menthol and albolene, 3 grains 
to the ounce (0.15 : 30.0), in order that the menthol may prolong the 
effect of the cocaine and prevent secondary congestion. This is now 
to be followed by inflation of the Eustachian tube with a Politzer's 
air-bag. Only in most obstinately painful cases of acute middle-ear 
catarrh is paracentesis of the drum to be attempted. Should true 
septic otitis media develop and drainage of the middle ear become impos- 
sible through blocking of the Eustachian tube, then the doctor must 
very gently irrigate the external auditory canal with as hot water as 
can be borne, and render it entirely aseptic by insufflations of boric- 
acid powder. These injections should be frequently practised, and 
if the pain persists and the tympanic membrane is bulging, para- 
centesis must be performed in the most bulging part of the lower 
quadrant. After the paracentesis needle is withdrawn the discharge 
should be allowed to flow freely. The canal is then to be well irrigated 
with hot carbolized water (1 to 50), and as the discharge is constant a 
piece of sterilized cotton inserted and removed as often as it becomes 
soiled. 

In the case of eczema of the ear hot irrigation, followed by the ap- 



606 DISEASES. 

plication of powdered iodoform, is perhaps the best application for tem- 
porary treatment. In furunculosis of the ear hot irrigation and free 
incision, with an iodoform dressing, are also useful. 

When foreign bodies cause the pain, they are best removed by 
repeated and gentle syringing with hot water. Forceps are danger- 
ous instruments in the hands of a novice treating the ear. 

In earache due to neuralgia a swab wet with chloroform may be 
applied to the skin in front of and behind the ear. 

ECZEMA.. 

This is probably the most common form of skin disease which the 
physician is called upon to treat, with the exception of acne. 

Dermatologists divide it into many forms and stages, but in this 
book a consideration of its forms is out of place, and only the treat- 
ment for its stages is proper. 

In the first place, it may be stated that the treatment is a quad- 
ruple one — namely, dietetic, hygienic, external, and internal. 

In regard to diet, the patient should be told to avoid salt foods, 
such as salt fish or pork and corned beef; greasy foods, such as bacon 
and fried dishes ; pastry and cheese. Only moderate amounts of wine 
and beer can be taken, and foods diflicult of digestion are to be 
stricken off the bill of fare. 

In the way of hygienic measures, fresh air, the avoidance of seden- 
tary habits, horseback exercise, or walking are to be recommended. 

External treatment is the most important of the two measures in 
which drugs are employed, and its course is perhaps best described 
by taking a case of ordinary eczema as an example and treating it 
through its entire course. 

In the early stages of an acute eczema, when the process is very 
active and the erythematous reddening of the beginning of the dis- 
ease is merging into the formation of vesicles or pustules, with the 
formation of large scabs, no application is better than oxide-of-zinc 
ointment, thoroughly applied night and morning. If the eczema be 
situated upon the scalp, the hair must be invariably clipped short or 
shaved off in such a way as to prevent the gluing of the hair into a 
mat by reason of the discharge. The ointment may be smeared over 
the part or applied on a piece of lint in a thick layer. Nearly always 
the ointment should be used in conjunction with black wash (calomel 
1 drachm [4.0], lime-water 1 pint [500.0]), which should be applied 
twice a day, just before the zinc ointment is resorted to, by means of 
a swab or a sop, and allowed to dry. In other cases the powdered 
oxide of zinc is dusted over the part if the discharge is very watery 
and profuse, or the following ointment, recommended by McCall 
Anderson, i< very efficacious: 

&. — Bismuth, oxidi 5j (30.0). 

Acid, oleic, pur .^viij (240.0). 

< terse albre 5iij (<)0.0). 

Petrolati ~ix (270.0). 

Olei rosae n^v (0.3). — M. 

I't. in unguent. 
S. — Apply to the part affected. 



ECZEMA. 607 

As the quantities of this prescription are large, they may be 
reduced one-half for use in limited eczema. 

Where the proliferation of cells and the secretion are very profuse 
it may become necessary to remove the crusts before the local remedies 
can reach the skin, and for this purpose poultices may be used ; or, if 
the disease be on the face, the parts should be anointed with olive oil, 
containing 1 or 2 minims of carbolic acid to the ounce (0.05-0.1 : 30.0), 
to soften the crusts, which are readily removed in a half-hour by the 
use of a little castile soap and water. The soap is not to be used if 
the inflammatory area is very angry-looking. Whenever itching is 
an annoying factor, the parts should be protected by lint smeared 
with some simple ointment, which may be carbolized both for its anti- 
septic and local anaesthetic effect. English and American dermatolo- 
gists use what is known as liquor carbon is detergens very largely in 
the acute stages of eczema as well as in other skin diseases. It should 
not be used pure, but diluted in such a way that for each 4 ounces 
(120.0) of water 2 drachms (8.0) of the pure liquor are present. 
Liquor carbonis detergens is made by taking 9 ounces (270.0) of 
tincture of soap-bark (quillaia-bark) and 4 ounces (120.0) of coal-tar, 
mixing and allowing them to digest for eight days, after which the 
mixture is filtered and used. 

When the disease has passed from the acute, active inflammation 
of the first stage to the subacute form of the second stage of its exist- 
ence, applications of a mildly stimulant character are necessary. 
Before this the physician has endeavored to soothe the parts ; now 
they must be excited to normal activity. For this purpose resorcin 
in the proportion of 2 to 30 grains to the ounce (0.1-2.0 : 30.0) of 
lard, according to the severity and induration of the lesion in the 
skin, should be used. Stelwagon recommends the following : 

R. — Unguent, picis liq. ^j (4.0). 

Unguent, zinci oxidi £vij (28.0). — M. 

S. — Apply to the parts. 

Where the disease is chronic and very persistent, but sluggish or 
atonic in its course, still more powerful remedies are necessary, such 
as salicylic acid, tar, or tincture of green soap used with hot water 
until the skin beneath is bared, dressing this by means of zinc oint- 
ment or resorcin ointment, 2 to 10 grains to the ounce (0.1-0.65 : 
32,0), spread on a cloth. The salicylic acid should be used in the 
proportion of 30 to 60 grains to the ounce (2.0-4.0 : 32.0) of lard, 
while the ^tar is used in the form of the pure official tar ointment. 

In seborrhoeic eczema, where the secretion is greasy and dry, and 
followed, if wrongly treated, by oozing and the pouring out of serum 
and the formation of cells which form crusts, the following prescrip- 
tion is of value : 

rjL — Resorcin gr. x vel xx (0.65-1.3). 

Unguent, zinci oxidi J ' ' ' o J \ • )• 

Petrolati . - gss (16.0).— M. 

S. — To be applied after removing the scabs by the use of a lotion composed of 1 
part of bay rum and 3 parts of water. 



608 DISEASES. 

The internal treatment is directed to the cure of any disordered 
function which is present, such as dyspepsia (see Indigestion), hepatic 
torpor, general debility, anemia, scrofulosis, inanition, constipation, 
gouty diathesis, or renal insufficiency. The gastric disorder is to be 
relieved by the use of hydrochloric acid and pepsin ; the hepatic tor- 
por by mercury, podophyllin. or, better still, by freshly-prepared 
undiluted nitro-hydrochloric acid added to water; the debility by 
tonics, such as cinchona, cod-liver oil, strychnine, and bitters ; the 
aniemia by iron. and. if scrofulosis exists, by the syrup of the iodide 
of iron. Constipation is to be cured by the use of proper foods and 
laxatives, and the gouty tendency counteracted by the employment 
of lithium citrate and colchicum or potassium iodide. If the kidneys 
are at fault because of torpidity, the diuretic potassium salts, such as 
the citrate, are indicated. Arsenic is never to be used, except in 
those instances where the skin is very dry. and where, by improving 
digestion and through its alterative power, it does good. In the 
chronic forms of dry eczema or those depending upon some atonic 
state of the trophic nerves of the skin, arsenic is of great value in 
the form of Fowler's solution, or arsenous acid may be given. 



EMISSIONS. 

Seminal emissions occur as the result of sexual abuse, whereby a 
condition of hyperexcitation of the nervous cells in the spinal cord 
and the nerves of the genitalia is developed, or they are due to 
peripheral or centric irritations, which reflexly irritate the genitalia 
or the nerves, and to a number of other similar causes. These emis- 
sions also occur with some periodicity in normal males who are con- 
tinent and chaste, and under these circumstances are not to be inter- 
fered with by treatment, unless the emissions become excessive. 

The former types are. however, proper for medical treatment, and 
their cure consists in the avoidance of unchaste literature and lasciv- 
ious thoughts during the waking hours, and the use of such spinal and 
cerebral sedatives that the centres governing the ejaculations of semen 
may be calmed, and so quiet a sleep produced that erotic dreams are 
avoided. The patient should sleep on a hard hair mattress, not be too 
heavily covered, and should avoid sleeping on his back, as this causes 
an undue blood-supply to the spinal centres, and consequent stimula- 
tion and ejaculations. Sometimes hard bodies, such as spools, are tied 
around the loins, so that lying on the back will cause so much discom- 
fort that the patient awakes and turns on his side. The drugs to be 
used are bromide of potassium or sodium in 20-grain (1.3) doses at bed- 
time, or chloral may be taken in the same amount. Hyoscine is cer- 
tainly of value in the dose of T -J-^ grain (0.0006). Sometimes a warm 
sitz-bath or genera] bath before going to bed is of service. In other 
cases, where atony is the cause of the trouble, the physician should 
recommend cold sponging of the perineum and loins night and 

mi n if. 

In tin- cases in which emissions come on as the result of continence. 



ENDOCARDITIS. 609 

and become excessive, the remedies just named are to be tried, but 
really do not effect any permanent cure unless used until sexual power 
is seriously depressed, so that it has been the custom of many physi- 
cians to recommend "marriage," which the patient may interpret in 
its legitimate light or not as he pleases. 

It is worthy of note that all irritations of the urinary bladder and 
other parts of the genito-urinary system should be removed, and it is 
often of value to administer citrate of potassium in 20-grain (1.3) 
doses, in water, three times a day, to render the urine non-irritating 
and alkaline. Stimulating foods and drinks are to be interdicted, and 
condiments, such as pepper and mustard, avoided. 

Sometimes, when the emissions are caused by genital atony, strych- 
nine and arsenic are of very great service if given in full dose. 

In many of these cases it is the duty of the physician to treat the 
moral state of his patient as well as to give medicines. Many per- 
sons, believing that emissions are always an evidence of disease, read 
books on such subjects which are sold by quacks and soon find their 
way to the hands of these persons, or sensibly consult a regular physi- 
cian. Half the treatment in these instances consists in assuring the 
patient that he has nothing to worry about, and in making him feel 
that the physician is his friend and worthy of all confidence and 
complete belief. 

ENDOCARDITIS. 

Endocarditis occurs sometimes as a single manifestation of disease ; 
sometimes as a symptom, with many others, of some general tendency 
produced by an infection, such as rheumatism or syphilis. Further 
than this, it may be acute, subacute, or chronic, and each one of its 
forms must be differently treated. It is hardly necessary to add that 
some of these states should be treated by antirheumatic or antisyph- 
ilitic remedies, such as the iodides. The iodides are not, however, 
indicated if any rapid changes of a degenerative type are at work. 

In acute sthenic endocarditis, associated with great vascular disturb- 
ance and much cardiac embarrassment or irregularity, there is no rem- 
edy so useful in the early stages as full doses of tincture of aconite, 2 to 3 
minims (0.1-0.15), given every hour until the physiological symptoms 
of its influence are felt, or, in its place, with equal efficacy may be em- 
ployed the tincture of veratrum viride (2 to 3 minims [0.1-0.15]). At 
the same time calomel and opium may be used, the calomel for its anti- 
phlogistic influence, and the opium to control the purgative tendencies 
of the mercurial. Thus we may use \ grain (0.015) of calomel every two 
hours and y 1 ^- grain (0.006) of morphine. Leeches should be placed over 
the praecordium in a goodly number, and if these are not obtainable 
wet cups are to be employed. In most cases it is better to apply an ice- 
bag over the heart. This depletion is only of service when the disease 
is seen early enough to allow us to limit the inflammatory process. As 
the disease progresses, if the physician fails to stop it, it will be found 
that the heart becomes somewhat labored in its action, irregular, and 
weak, and that its rhythm is seriously interfered with. At this time 

39 



610 DISEASES. 

digitalis is of use in stimulating the depressed cardiac muscle and 
increasing its reflex activity, also steadying it through the pneumo- 
gastric irritation which it produces. Aconite and other depressants 
are contraindicated at this time. Absolute rest upon the back is to 
be insisted upon. During the course of acute rheumatism a number 
of small blisters placed on the praecordium will be of value in prevent- 
ing endocardial complications. If the disease becomes ulcerative, 
supporting treatment, consisting chiefly in the use of good food and 
the free administration of the tincture of the chloride of iron, is of 
great value. 

EPILEPSY. 

The disease known as epilepsy is probably the most disheartening 
condition as to treatment that the physician has to deal with, since it 
often resists the influences of all the standard remedies, and drives the 
practitioner from drug to drug in the hope of finding one which will be 
at least alleviating in its effects. For this reason the author has in this 
article included many of the drugs which are rarely used, as well as 
those generally recognized as useful in its treatment, in order that the 
physician may try every remedy of any possible value. 

It should be borne in mind that the treatment of epilepsy is as 
various as the disease is variable in its forms and phases, and should, 
in nearly all cases, resolve itself into two or perhaps three divisions, 
consisting in the removal of any exciting cause, in the checking of 
the convulsive tendency already set up, and in the prevention of any 
further attacks by suitable drugs or other measures of relief. 

The treatment is governed largely by the cause, and is medicinal 
or operative according to the etiological factors at work. In simple 
idiopathic epilepsy medicinal means must be followed, while in a case 
resulting from traumatism the depressed bone, abscess, or tumor must 
be removed, and in those due to reflex irritation the peripheral source 
of trouble must be sought out and relieved. 

So far as drugs are concerned, the most valuable remedy in use 
for the relief of epilepsy is bromide of potassium, although other 
forms of bromide salts are to be mentioned later on. 

This drug, however, is not a "cure-all," even in epilepsy, and 
reports are constantly made of cases where it has failed ; but many 
cases prove that the remedy is undoubtedly responsible for a cure 
when it is pushed in a suitable manner, a] id in the vast majority 
of instances the seizures are so decreased, both in violence and fre- 
quency, that its use may be said to be indicated in every case of the 
disease. 

In a very small minority, however, it signally fails, and in a still 
smaller number of cases it is useless unless combined with some other 
drug whose power alone is very slight. 

Tlio doses to be used vary to a considerable extent with the salt 
employed, and depend upon the character of the disease and the tem- 
perament and physique of* the patient. The greater the duration of 
the disease, the greater is the difficulty in effecting a cure, and the 



EPILEPSY. 611 

length of time which the child has been epileptic should therefore be 
most carefully reckoned before the treatment begins. Further than 
this, the frequency and severity of the attacks are to be looked into, 
and these points are really more important than the actual duration 
of the ailment ; since if a man has only one fit every six months for 
twenty years his condition is far less serious than if he has a history 
of three or four fits a day for one year. Again, the character of the 
attack, as to its violence, may be the most important fact to be re- 
garded, for if it is violent enough to endanger life, remedies must be 
pushed even beyond the point of tolerance. The writer once heard 
a very celebrated physician cause much amusement among his auditors 
by detailing an instance of an epileptic who was getting well, and 
would have recovered if he had not died. His explanation was, that 
the man was syphilitic, and was receiving moderate doses of iodide 
and bromide of potassium, which were slowly benefiting him, and 
would have cured him had not a single severe fit produced death in 
the mean while. Another point to be considered is the condition of 
the digestion, which the bromide of potassium is peculiarly liable to 
disorder, and which is sometimes so disturbed as to necessitate the 
administration of the drug by the rectum in serious cases. Females 
generally require smaller doses than males, and children of both sexes 
do not require as large quantities as adults. The dose to be used in 
the beginning of the treatment in moderate cases is about 10 grains 
(0.65) thrice a day ; and while this may seem a very small quantity, 
it will be found that it can be rapidly increased in amount without 
causing the gastric distress produced by the sudden use of larger 
doses. Each day an additional 10 grains mav be added, until at the 
end of a week the patient is taking 80 grains (5.3) in each twenty- 
four hours. There are very few cases which will not become com- 
pletely saturated with the drug if this is done, and there are very few 
in which a more rapid arrival at bromism is needed. If, however, the 
patient has become able to stand large amounts by the prolonged use 
of the drug, the amount given is not to be governed by grains, but by 
physiological effects, and it may be pushed to any amount which is 
borne without distress. Recently European physicians have endeav- 
ored to aid in the rapid saturation of patients by the bromides by 
depriving them of common salt, thereby leading the salt-starved system 
to greedily absorb the bromide of sodium. It is doubtful if this plan 
is justifiable. 

In chronic epilepsy, too, with regularly recurring fits, the greatest 
good is obtained by pushing the drug in ascending doses for one week, 
and then for the succeeding week only enough is given to preserve 
the general effects of the medicament. By doing this the stomach 
gets a rest and the appetite is not greatly interfered with. Where 
the attacks occur only every two weeks, this is a particularly useful 
method for obvious reasons. As regards the time of day when the 
drug is to be taken, there can be no doubt. Some writers have 
directed that it shall always be taken before meals, but this is entirely 
lacking in advantage and decidedly fruitful of harm. Medicines 
which are given with the object of affecting the general system should 



612 DISEASES. 

be taken after meals, not before, and it is only when a local gastric 
effect is desired that we use them on an empty stomach, particularly 
when the substance is as irritant and depressing as potassium. If 
taken after meals the appetite is not decreased, but there are few who 
can take a dose of 10 or 20 grains (0.65-1.3) of bromide of potas- 
sium before breakfast without suffering from indigestion. It has been 
held by some that the drug should be taken in minute doses, fre- 
quently repeated, in order to keep the patient constantly under its 
influence. This is an example of therapeutic ignorance, because 
bromides are slowly eliminated, and this frequent administration pos- 
sesses the disadvantages of being inconvenient, annoying, and apt to 
disorder the stomach. In this connection it is not to be forgotten that 
the use of full doses of the bromides, particularly in epileptics of an 
advanced type, sometimes causes maniacal outbursts in place of the 
epileptic attacks. In other instances the patients become morose and 
homicidal. (See article by author in Therapeutic Grazette, June, 1897.) 
Cases are on record in which the persistent use of large doses of the 
bromides has resulted in bronchitis with profuse and dangerous exuda- 
tion, causing suffocative bronchitis. 

If the attacks have a distinct periodicity or can be foretold for as 
much as two hours beforehand, the remedy may be taken in a large 
dose only at this time, and but a few grains given in the intervals ; 
and if the attacks are severe, no one should hesitate to use large doses 
by the mouth and by the rectum on the day of the attack. 

A very important point to be borne in mind is that the drug often 
seems to have almost produced a cure, and this results in carelessness 
in the regularity of administration. The patient should be impressed 
by the fact that every day passed without a fit is a step forward, and 
that every fit carries him many steps backward. He should also be 
directed to use the drug, in moderation, for at least three years after all 
fits have ceased, and to Avatch after that time for the slightest sign of 
their return. The quantity taken each day should be gradually de- 
creased, not suddenly stopped short. 

It is true also that if a recurrence of the fits takes place they yield 
to treatment very much more slowly than before. 

Before passing on to the discussion of the other bromides, and the 
conditions produced by the excessive use of all of them, we may 
place our use of these compounds in epilepsy on a scientific footing. 
It is now generally recognized that the seizures known as epilepsy 
arise from the cells in the cerebral cortex, and there can be no doubt 
that the bromides act very powerfully upon the cerebrum in the 
higher animals, decreasing the irritability of the motor centres in 
these regions to a very great extent. Not only is this pointed to by 
clinical facts, but the well-known researches of Albertoni prove that 
such is their action beyond all doubt. This investigator found that 
the administration of a single dose of the bromide of potassium so 
lessened the excitability of the motor cells in the cortex cerebri that 
much Btronger stimulation was necessary in order to cause response 
in the Limbs than was normal, and that it was difficult to produce 
epileptic attack- by means of the electrical stimulation of the motor 



EPILEPSY. 613 

areas, even when currents very much stronger than those which com- 
monly produce such a result were used. He also found that this 
lessened irritability was increased still further if the drug was given 
for several days beforehand in such doses as thoroughly to impress 
the organism. It is therefore evident that the bromides act directly 
on the cortical areas, calming the tendency to explosions of nerve- 
force. 

There is one more point to which attention must be called, and that 
is the fact that when the bromides are taken for any length of time 
they produce bromism, which in its moderate or severe forms produces 
a mental condition very closely allied to that seen in old, chronic epi- 
leptics. This condition of the mind should never be overlooked, and 
the ordinary mental changes of epilepsy are greatly increased by its 
constant and careless administration. (See Bromide of Potassium.) 

The bromide salts of gold, iron, sodium, lithium, nickel, and 
ammonium have all been used in epilepsy with good results, but, 
except in certain instances, they fail to act as well as that of potas- 
sium, unless given in larger doses. There are several circumstances, 
however, under which each one possesses marked advantages, and 
may suceed where potassium has failed. In all cases of epilepsy 
complicated with anaemia the bromide of iron should be employed, 
but where there is plethora it will generally increase the disease or 
do no good. When it acts after potassium fails the iron is of value, 
because of its tonic and nutritive effect. Bromide of sodium, while 
somewhat less powerful than potassium, is not by any means so apt to 
disorder the stomach, and is preferable in some cases on this account. 
It possesses no other advantages. 

The bromide of lithium has been highly recommended in intract- 
able cases by Weir Mitchell, who even states that it may be given in 
one-half the dose of the potassium salt with equally good effects. 

The bromide of nickel is said to relieve some cases where all other 
remedies fail, but this occurrence is rare. In a series of physiological 
experiments made by the writer some years since he found it virtually 
identical with the potassium salt in its action, and it is useful in about 
the same doses and cases as is bromide of potassium. 

The bromide of ammonium is quite irritant and disorders the 
stomach very readily. It ought always to be used, when used 
at all, with other drugs, the ammonium salt acting only as an 
adjuvant. 

Several clinicians have tried hydrobromic acid, but it is very much 
more apt to derange digestion and to produce vomiting than any of 
the salts. The dose of the dilute acid is J to 3 drachms (2.0-12.0) 
in a tumblerful of sweetened water. 

The bromate of potassium has been used by Mitchell in doses of 
not more than 5 to 10 grains (0.3-0.65) with good results, but is more 
dangerous and scarcely of greater value. 

There can be no doubt that in some instances what is known as 
the mixed treatment is successful when all else fails. This consists 
most commonly of a prescription in which the bromides of potassium, 
sodium, and ammonium take part. Why this combination acts better 



614 DISEASES. 

than any one of the salts alone no one knows, but it is certainly a 
clinical fact. 

Bechterew has recommended the joint use of the bromides with 
adonis vernalis in epilepsy as follows : 

R.— Potassii bromidi ^iij (12.0). 

Infus. adonis vernal ^E} v (120.0). 

Aquae destillat q. s. f^vj (180.0).— M. 

S. — A dessertspoonful three times a day. 

Sometimes codeine is combined with this prescription. 

Within the last few years it has been claimed by Flechsig that the 
use of opium for a long period of time is useful in the treatment of 
epilepsy. He gives the opium in ascending doses during a period 
of six weeks, beginning with \ grain (0.018) three times a day and 
going as high as 5 grains (0.33) three times a day. This method de- 
creases the frequency and severity of the fits for several months in 
some cases, but does not cause a cure. It succeeds best in old cases 
and is not useful in recent ones. 

In still other cases digitalis, when used along with one of the bro- 
mides, seems to produce favorable results. Indeed, digitalis has for 
years been used alone in epilepsy w T ith fairly good results, and should 
always be used in obstinate cases. In petit mal, where bromide of 
potassium when used alone so often fails, it is useful, and several 
English writers, notably Gowers, assert that its best effects are in 
cases of nocturnal epilepsy. Why this should be the case no one 
knows, and it would seem doubtful whether it does any more good in 
nocturnal attacks than in others. 

Another combination very much employed and lauded is bromide 
of potassium with belladonna, the mydriatic being almost useless 
alone, but of great antiquity in its use in epilepsy. Like the mix- 
ture of digitalis and bromide, it succeeds very frequently in petit mal, 
and, indeed, seems to be much more successful than the digitalis, but 
its mode of action is exceedingly doubtful. As the drug acts even 
more powerfully upon the nervous system than upon the circulatory 
apparatus, it has been thought that its influence for good depended 
upon this effect, but the experiments of Seppilli contradict this belief, 
for he found that if atropine was given to an animal the surface of 
the cortex cerebri responded more readily than is normal to electrical 
stimulation. 

At one time it was held that belladonna acted on the spinal cord 
and peripheral nerves under such circumstances, but it should be 
remembered that we now know that atropine is only of value in relax- 
ing spasm when given in full dose, oftentimes hypodermically, and 
that Albertoni has made a series of experiments to determine whether 
it irritates the motor centres of the cortex. In his hands repeated 
small doses or one large dose in no way retarded the convulsions com- 
monly produced by stimulation of the brain. Both these investigators 
are therefore in accord. Under these circumstances it affects rather 
the motor nerve-endings than the central nervous apparatus. 

Aj l"ii'_ r ago as the early part of this century cannabis indica came 



EPILEPSY. 615 

into notice in the treatment of epilepsy, and it is probably of greater 
value alone than when combined with any other drug, unless it be 
with the bromides. Although it is" at present rarely so used, the 
author believes, from his own studies, that it is of value, for he found 
that it distinctly lessens reflex action and acts powerfully upon the 
higher nervous centres in the brain. Its use and value in migraine 
are undeniably of the greatest importance, and epilepsy and migraine 
are often very closely allied. 

Nitrate of silver was brought into use long before the value of 
more recent drugs was known. Every one is agreed that it is with- 
out power for good, save when it is used constantly for a long time. 
As the drug is eliminated very slowly, it rapidly accumulates in the 
body, and argyria soon comes on. It may be used, after all else fails, 
in doses of -J- to J grain (0.01-0.15) thrice a day after meals, the 
mucous membrane of the inside of the lips and the conjunctiva being 
carefully watched for the early signs of chronic silver poisoning. We 
certainly have no knowledge as to its influence on the nervous sys- 
tem ; and if it acts at all, it must be by some alterative influences 
rather than by any other means. 

Nitroglycerin is to be employed in the treatment of petit mal, 
rather than haut mal, in the dose of 1 minim (0.05) of a 1 per cent, 
solution, once, twice, or three times a day. Our knowledge of its 
effects, so far as its curative influences are concerned, is very slight, 
but it seems to benefit some cases. Its action is very fleeting, and it 
influences the brain very little, except it be taken just before an 
attack is expected or when the cardiac action is defective. Its great 
lethal power should never be forgotton. 

The use of the nitrite of amyl is not for the purpose of directly 
curing the disease, but of warding off impending attacks, the warn- 
ing of which is given by an aura of slow progression. It increases 
the severity of petit mal, but in epileptics who have a prolonged aura 
we may use nitrite-of-amyl pearls, which consist in small glass beads 
containing a few drops of the drug. As the aura comes on the 
patient should break one of these in his handkerchief and inhale 
the drug, thereby putting aside the attack. The influence which the 
drug exerts upon the brain is secondary rather than primary, and is 
probably dependent on its action on the blood or circulation. Its 
influence on the spinal cord and nerves is much more marked and 
direct, and it is most certainly a very powerful spinal depressant. As 
its influence over unstriated muscular fibre is very great, it affects the 
vasomotor system very powerfully ; and those who think epilepsy is 
due to a vasomotor spasm at the base of the brain point to the effects 
of this drug as a proof of their hypothesis. Such reasoning is not, 
however, necessarily correct. Nitrite of amyl puts aside an attack by 
a sudden shock to the nerve-centres, which diverts them, so to speak, 
from their intended discharge, very much as a ligature around the 
arm stops an aura. When we remember that the drug acts instantly 
and converts nearly all the oxygenating blood of the body into a non- 
oxygen-carrying fluid by reason of the methsemoglobin produced, the 
sudden change in the cerebral nutrition and state is easily understood. 



61 6 DISEASES. 

In the treatment of the "status epilepticus " nitrite of amyl is of 
great value in stopping the seizures, and may be used under these 
circumstances in heroic amounts, applied to the nostrils at intervals. 
During the presence of the tonic spasm, if it be severe enough to stop 
respiration, it should be remembered that if the drug is not inhaled 
it is absolutely worthless. It is only when respiration is being carried 
on that it can enter the lungs and do its work. Another valued 
method in treating the status epilepticus is free bloodletting. The 
nitrite of ammonium or of sodium should be used internally to sup- 
plement the nitrite of amyl. 

The use of anaesthetics during an attack of epilepsy is virtually 
useless, and in some cases dangerous, for ether is too slow in its effects, 
and may, by its irritant vapors, increase the tendency to laryngeal 
spasm or cause lung complications. Further than this, if uraemia is 
the cause of the fit — and this fact is unknown in every case until the 
individual is carefully examined — the ether may increase the inflam- 
mation of the kidneys very seriously. 

Chloroform, though it acts much more rapidly, may cause sudden 
cardiac failure, and both drugs may increase the post-convulsive coma 
very greatly. In "status epilepticus " they may be used, as in such 
cases the convulsions must be stopped at all hazards, but the prefer- 
ence should be always for amyl nitrite. 

The iodide of potassium is entirely useless in epilepsy unless the 
disease is due to syphilis, when it is of the greatest service. Indeed, 
the bromide and all other drugs should be set aside while this one is 
pushed to the utmost. As is well known, syphilitics usually bear the 
drug extremely well, and the author knows of one instance where no 
less than 800 grains (53.0) were taken every twenty-four hours, with 
rapid improvement as a result. This point is strongly insisted upon 
by all therapeutists and syphilographers, notably among whom stands 
Fournier. 

Where the convulsions are due to the presence of a gumma, the 
iodide of potassium is, however, too slow in its action, and should be 
associated with mercury in order to break down the growth without 
delay, lest a seizure cause death by glottic closure, producing asphyxia 
or some similar accident. 

Chloral hydrate is a remedy which has been only partly tried in 
epilepsy, and its usefulness is not as yet determined. It possesses the 
marked disadvantage, as compared with the bromides, of being a 
very fatal poison, which is an important fact to be borne in mind by 
the physician when giving it to a patient whose mind is already weak- 
ened by the disease or naturally stupid, and who may forget and take 
too much. Irs physiological action indicates much more fully that it 
may be of value than does that of many other much more lauded rem- 
edies, since it exerts its chief influence on the motor pathways of the 
spinal cord and quiets the motor portion of the cerebral cortex, and 
also produces sloop. Seppilli has proved this by direct experimenta- 
tion after the method employed by Albertoni. Its use, combined with 
one of i he bromides, is often accompanied by the most desirable results, 
and it should he tried at all times unless some cardiac complication 



EPILEPSY. 617 

forbids it. It may disorder the stomach, and should, like the bromides, 
always be given well diluted and after meals. 

Of the more recent remedies, acetanilid certainly stands in the 
foremost rank, and bids fair in some instances to rival the bromides. 
Professor Germain-See, the author, and some others have reported 
cases which obtained very marked relief from it, and more recent 
investigators have done likewise. The drug will be found to exert 
its chief benefits in chronic epilepsy. At least, if a child was brought 
to the author with a beginning epilepsy he would use the bromides, 
but, if the disease was chronic, acetanilid. 

Antipyrin has been recommended by Lemoine in certain forms of 
epilepsy, but is condemned in many cases. In those who suffer from 
menstrual epilepsy, so called, or in those in whom the attack seems to 
be produced reflexly by the presence of intestinal parasites, the drug 
does good. 

Lemoine also found it very useful in those cases which are asso- 
ciated with migraine. In these cases the results were better than 
with the bromides, but in the idiopathic simple varieties it was useless. 
Mairet and Combemale have used the drug in epileptiform mania with 
satisfactory results. 

In the epilepsy of childhood Solanum Carolinense in the form of 
the fluid extract, in the dose of 2 to 15 minims (0.1-1.0 cc), is some- 
times a useful drug. 

The value of the treatment of epilepsy by borax has not received 
very wide recognition. Perhaps the most thorough studies of its 
effects have been those of Gowers in England and Folsom in America. 
It would seem that some cases which are obstinate under ordinary 
treatment are benefited by borax, but it is certainly not to be com- 
monly employed. The dose generally given is about 15 grains (1.0). 
(See Borax.) 

In children suffering from frequently recurring epileptic attacks 
the presence of worms should always be looked for, and when they 
are found they should be expelled as rapidly as possible. If they are 
the oxyuris vermicularis (seat-worms), the best remedy by far is the 
injection of a strong infusion of quassia of such a strength that there 
are 2 ounces (60.0) of quassia to each pint (500 cc.) of water. 

In girls, where the removal of the worms from the rectum is not 
followed by relief, a careful examination of the vagina should be 
made, and quassia employed in somewhat weaker solution, as very 
commonly intense inflammation is there present, produced by migra- 
tory movements of rectal parasites. If the quassia is unobtainable in 
any case, a saturated solution of chloride of sodium may be employed. 

A very important point, which is constantly brought before the 
physician who is treating epilepsy, is that of diet. Nearly every 
patient who suffers from this disease inquires what he shall eat. Very 
few researches of a thorough character have ever been carried out on 
a large scale to determine the things which may or may not be in- 
gested. Of course, nearly every one of us knows from our personal 
experience that red meats are hurtful, particularly in children. Curi- 
ously enough, the influence of diet in one research covering a number 



618 DISEASES. 

of cases of chronic epilepsy seemed to be of little moment. Thus, 
Merson examined 24 such cases, putting 12 of them on a purely vege- 
table, and 12 on a purely nitrogenous, diet. The result, after this 
study had been continued for two months, was that the vegetarians 
had had a few less fits than the others, but the difference was so slight 
as to be of almost no weight in determining the question. Some 
authors at the present day believe this opinion as to the harmfulness 
of meats to be erroneous, and Gowers is one of them. 



EPISCLERITIS. 

Episcleritis, or inflammation of the episcleral tissue, manifests 
itself in the form of dusky-red, subconjunctival swellings, over which 
the conjunctival vessels are coarsely injected and the surrounding 
conjunctiva cedematous, and which usually appear in the ciliary region 
on the temporal side of the cornea. Occasionally the inflammation is 
diffuse and the injection bluish-red in color. This disease may be 
due to rheumatism, gout, scrofula, and menstrual derangements, is 
very prone to relapse, and sometimes stubbornly resists treatment. 
This, in addition to atropine locally and mild antiseptic collyria, should 
include the internal administration of remedies indicated by the 
underlying constitutional cause, particularly the salicylates, iodide of 
potassium, jaborandi-diaphoresis, etc. Naturally, menstrual and uter- 
ine disorders must be rectified. A peculiar variety of episcleritis, 
known abroad as periodic fugacious episcleritis, and in England as 
" hot eye," but in this country as vaso-motor dilatation of the vessels, 
appears in the form of patches of episcleral injection or oedema of 
violaceous hue, lasting from two to eight days and reappearing again 
at intervals of several weeks, or even months. Almost always gout 
and rheumatism are the associated dyscrasias, and suitable constitu- 
tional remedies must be exhibited. 



EPISTAXIS. 

Nose-bleed depends upon many causes, the chief of which are 
traumatisms, plethora, and the presence of ulcerations in the nasal 
chambers. It also occurs as one of the prodromata of typhoid fever. 

Probably plethora is the most frequent cause of nose-bleed, and in 
most instances it is an attempt on the part of the system to rid 
itself of an excess of blood. Under these circumstances epistaxis 
is not dangerous, nor is it proper to arrest it unless it becomes exces- 
sive. When it is excessive or must be controlled for any reason, the 
measures to be adopted are both medicinal and non-medicinal. If 
the person is full-blooded and strong, full doses of tincture of aconite 
or veratrum viride arc useful, say 2 to 4 minims (0.1-0.2) of one of 
them, followed in ;i half-hour by a smaller dose, if necessary. The 
value of these drugs depends upon their power of lowering blood- 
pressure, and in consequence decreasing the leakage from the break 



ERYSIPELAS. 619 

in the wall of the blood-vessel. Some physicians have recommended 
ipecac in full nauseating doses to relax the arterial system. Ergot 
in the form of the fluid extract in the dose of 1 drachm (4.0) may 
be given, or its wine in the dose of a wineglassful (32.0) employed. 
Sometimes, when the oozing is slow, turpentine, oil of erigeron, or 
hamamelis. taken internally, do good. In the way of local treatment 
adrenalin chloride in salt solution 1 : 1000 should be placed in the nasal 
chambers on a piece of cotton, and powdered alum, pure or half and 
half with starch, or alum in solution, may be snuffed up the nostril, 
and tannic acid, in powder or in solution, may be used with advantage. 
If this does not control the hemorrhage, an atomized spray of MonsePs 
solution, in the strength of 30 minims to 4 ounces (2.0 : 120.0) of 
water, may be of service. 

All these remedies act as styptics when locally applied, by causing 
coagulation of the fibrin and the formation of a clot, while the inter- 
nal remedies produce local contraction of the blood-vessels in the con- 
gested area. 

The non-medicinal measures to be employed if the bleeding is 
severe consist in plugging the anterior nares with pledgets of cotton 
or pieces of lint soaked in vinegar. If this does not control the 
hemorrhage, the posterior nares may also be closed by plugs, and 
compression of the facial artery of the same side as the bleeding nos- 
tril be made upon the superior maxilla near the nose, thus decreasing 
the blood-supply. The head must be kept raised, and the patient 
must not bend over a basin or wear a tight collar. 

A piece of bacon fat cut to fit and placed in the nostril may stop 
epistaxis which has resisted all other measures. 

As a household remedy vinegar may be injected into the nostrils, 
or lemon-juice may be employed in the same way. 

Sometimes, if the patient raises one or both hands high above the 
head, the hemorrhage ceases. This is due to the fact that the easiest 
pathway for most of the blood is straight up the brachial arteries 
rather than through the tortuous vessels of the face. A hot foot- 
bath, by dilating the veins of the lower extremities, draws away the 
blood from the face and is a useful measure. In other cases a hot- 
water bag applied over the dorsal vertebrae is efficacious, and some- 
times cold when so used is of service. A piece of ice pressed against 
the nose may prevent further hemorrhage by causing localized 
anaemia. 

Where the nasal hemorrhage results from traumatism with fracture 
of the bones, and great loss of blood ensues, ligation of the bleeding 
vessel or its supplying vessel should be performed if possible. 



ERYSIPELAS. 

This disease is now generally recognized as dependent for its 
existence upon a germ. The streptococcus of erysipelas is practi- 
cally identical with that of pus, and the disease is at first a distinctly 
local one. The changes which have come forward in its treatment 



(320 DISEASES. 

are chiefly the local measures, while those methods which have been 
used internally for many years have suffered no alteration. 

Whether or not erysipelas is a local or systemic disease has little 
to do with the proper treatment. In any case it is an inflammation, 
and as such it must be treated. In its early manifestations and where 
some uncertainty may exist as to its true character aconite or vera- 
triim viride mav be used in sthenic cases in which the nervous and 
circulatory systems give evidence of reflex irritation and the pulse is 
hard and full. These remedies are contrainclicated if any tendency 
to weakness exists. DaCosta has recommended, and others have car- 
ried out with success, the practice of using jDilocarpine in sweating 
dose (J to jr grain hypodermically) in these early stages. (See Pilo- 
carpus.) As with aconite and veratrum viride, it is to be remembered 
that this use of pilocarpine is not to be resorted to if debility exists. 

The internal treatment of erysipelas par excellence is the plentiful 
use of the tincture of the chloride of iron — 20 to 30 minims (1.3-2.0), 
or even 40 minims (2.65), well diluted, four times a day. The diet 
should be regulated and the bowels kept in good order, while any 
excessive febrile movement is to be treated by the use of cold bathing. 
Where the patient passes into the typhoid state supportive measures 
must be used and alcoholic stimulants added to the food, which should 
be predigested or prepared so as to be readily absorbed. 

During convalescence the use of tonics, both in the form of iron 
and of bitters, is particularly indicated if the recovery of strength is 
slow. The local treatment of erysipelas is very varied, but in the 
majority of cases resort need be had to but one method. 

By far the best dressing for the general run of cases of erysipelas 
is a modification of that of Yon Xussbaum. which the author has tried 
in a great number of cases with success. The skin of the part involved 
is carefully cleansed with Castile soap of the purest form, and then it 
is washed off with a 1 : 1000 solution of bichloride of mercury. The 
skin is dried with a soft towel, and a thick coating of ichthyol with 
vaseline or lanolin applied, the strength of this ointment being half 
and half. Over this is placed antiseptic gauze or sterilized absorbent 
cotton, and adhesive strips or a bandage is used to keep the dressing in 
place. Sometimes the ointment alone may be applied if the area is 
small. Under this treatment the results are often extraordinary in all 
stages of the malady. Where ichthyol is not obtainable, a thick coat 
of white-lead paint, as it is sold in cans before it is mixed with any 
thinning substance, will be found of service in an emergency. 

The plan recommended by Iligginbottom, of applying nitrate of 
silver, is sometimes successful. It consists in the use of a solution 
of the strength of 80 grains to 4 drachms (5.3:16.0) of distilled 
water, which is thoroughly applied with a camel's-hair brush over the 
entire inflamed area and for a little space beyond. The application 
musl be made twice or thrice to secure a good coating. This treat- 
ment will often arrest the inflammation and prevent its spread, but 
ias caused sloughing. 



EYESTRAIN— FEET SWOLLEN, TENDER, OR SWEATING. 621 

EYE-STRAIN. 

Eye-strain, in the broadest acceptation of the term, is the name 
applied to those symptoms which may be caused by the presence of 
refractive error, or imbalance of the ocular muscles. While all varie- 
ties of ametropia may cause eye-strain, hypermetropia and astigmatism 
are most potent in this respect. Fully 60 per cent, of functional 
headaches are caused by refractive errors ; and these headaches may 
vary from a moderate frontal distress to violent explosions of pain, 
and may be situated in any portion of the cranium. Moreover, they 
may be entirely unassociated with any pain in the eyes or any ap- 
parent disturbance of vision, and are frequently caused by low de- 
grees of refractive error ; in fact, they are perhaps more frequently 
caused by them than by the higher defects. In addition to headache, 
eye-strain may cause pain in the back, especially between the shoulder- 
blades and at the root of the neck, precordial pain, vertigo, drowsi- 
ness, insomnia, habit-chorea, choreiform movements, convulsive seiz- 
ures, melancholia, neurasthenia, palpitation of the heart, night-terrors, 
stomachic disturbances, flatulent dyspepsia, and a variety of general 
or so-called reflex neuroses. The existence of any of these symptoms 
or affections should direct the attention of the attending physician to 
the condition of the eyes, and refractive error and muscular imbalance 
should be corrected. 



EXHAUSTION AND DEPRESSION. 

While the treatment of both these conditions is almost identical in 
some respects, it is nevertheless important that a clear idea of the 
difference between the two be clearly understood, if for no other 
reason than that the physician may recognize that exhaustion is a 
far more serious state than depression. It also requires more careful 
treatment. The man who is depressed retains in his body all the 
vital forces necessary for the maintenance of life, but they are tem- 
porarily in abeyance from some cause. As soon as the incubus is 
taken away the system at once asserts itself and recovery takes place. 
This is not the case with a man suffering from exhaustion. In this 
patient every particle of his strength is sapped and lost. The man 
depressed is the giant lying unconscious from a blow on the head ; 
the man exhausted is the same giant after a long attack of typhoid or 
other fever of a similar nature. The treatment of depression is stim- 
ulation ; of exhaustion, not only stimulation, but feeding and protec- 
tion from exposure. 

FEET SWOLLEN, TENDER, OR SWEATING-. 

These comparatively simple yet annoying conditions are often 
brought before the physician for relief, and patients suffering from 
them will frequently be more grateful for skilful treatment than in 
the event of recovery from a severe illness. 



622 DISEASES. 

Swelling of the feet occurs chiefly in two classes of cases, except- 
ing, of course, dropsy. The two classes named are old persons 
taking too little or too much exercise, and who may have gouty or 
rheumatic tendencies, and those who by constant standing or walking 
cause congestion of the lower extremities, chiefly by fatigue, or by wear- 
ing bad shoes, or by running over uneven ground, causing bruising. 
"Where the swelling takes place in the first class, small doses of arsenous 
acid. -gL to -fa grain (0.001-0.0015), often do good, and careful ex- 
amination should be made of the circulatory, renal, and respiratory 
apparatus to discover any weak points, such as vascular relaxation or 
tendencies to varicosities. The distilled or fluid extract of hamamelis 
is often of service in the dose of \ to 1 drachm (2.0-4.0) of the former 
and 10 to 20 minims (0.65-1.3) of the latter preparation. In some 
cases absolute rest of the feet will be necessary before a cure is reached. 

Where the feet are tender the most common cause is bruising from 
too thin soles on the shoes, too tight shoes, and from abrasions or skin 
disease. More commonly than all they become sore from excessive 
sweating and resulting maceration. 

The treatment of sweating and tender feet is, of course, the removal 
of the cause and the use of remedies designed to toughen and harden 
the skin of the parts. Probably the best application for this purpose 
is a solution of salicylic acid and borax, half and half, in water and 
glycerin, rubbed over the feet night and morning. If the sweating is 
very severe, clean stockings should be worn each day, the stockings 
being previously soaked in a strong solution of borax and dried. The 
following prescription affords a useful powder : 

R. — Pulv. acidi salicylic! gr. xx vel xl (1.3-2.65). 

Pulv. acidi borici ^ij (8 0). 

Pulv. arayli q. s. ad sj' (32.0).— M. 

S. — To be dusted over the feet night and morning, after washing and thoroughly dry- 
ing them. 

One of the most efficient applications is a solution of formaldehyde 
of such strength that 1 part of the commercial 40 per cent, solution 
is mixed with 4 parts of water. Even this may be too strong in some 
cases. A more agreeable application is diluted euformol. 

Sometimes the use of cotton instead of woollen stockings may aid 
in the cure. 

FEVER, AND ITS TREATMENT. 

{For the Treatment of each Fever, see its Title.) 

At the present time the medical profession is universally of the 
opinion that fever is a disorder of calorification dependent upon 
nervous action, said nervous action being the result of various causes. 
such ;i> the presence of poisonous materials in the blood causing per- 
verted functional activity of heat-centres. Turning from the question 
of the production of fever to those methods and drugs which combat 
it. the rule of practice should be to control all fevers by the use of 
cold sponging or bathing and to resort to antipyretic drugs as little as 
possible. 



FEVER, AND ITS TREATMENT. 623 

The value of a drug which can decrease high temperature by influ- 
encing heat-production alone cannot be over-estimated, and while sev- 
eral drugs seem to influence this part of the heat apparatus more than 
that portion connected with the dissipation of heat, we have no sub- 
stance which is distinctly and solely capable of exercising an inhib- 
itory power over the development of heat in the body. For practical 
purposes we may therefore divide antipyretics into three great classes : 
First, the substances which allay or prevent fever by inhibiting its 
production ; second, the drugs which possess the power of decreasing 
bodily temperature by increasing the dissipation and decreasing the 
production of heat ; and third, the compounds which allay fever, not 
by stopping the manufacture of heat-units, but by so increasing the 
exhalation of heat that the loss is greater than the manufacture. 
The first and last of these three classes are directly opposed to one 
another. The second class is half-way between, and it is to this class 
that most of our antipyretic drugs belong. The first is the ideal ; the 
second is the one we have to be content with ; the third is the one used 
by our forefathers. 

The objection to the use of all antipyretic drugs is that they de- 
press the patient and decrease his power of resisting disease. 

The presence of a high temperature alone does not constitute the 
sole indication for treatment. The physician should be governed by 
the state of the patient who is laboring under the malady. A temper- 
ature of 106° F. in a young healthy man suffering from an attack of 
some disease of short duration does not mean very great danger, but 
a temperature of 103° day in and day out in typhoid fever does mean 
danger, and must be carefully attended to. The question is one not 
of actual degrees Fahrenheit, but rather as to whether the state of 
the patient is serious. 

We have only two measures for the relief of fever which are reli- 
able and have stood the test of time. These are the employment of 
antipyretic drugs, and the use of cold water. Drugs are to be used 
very rarely, but the beneficent effects of the use of cold water are 
extraordinary, and it should be freely employed if the fever is high. 
(For the mode of using antipyrin and acetanilid see pp. 44 and 86, 
and for the use of cold see p. 443.) 

Some physicians have doubted the feasibility of resorting to cold 
bathing in private practice. There can be no doubt of its acting well 
under these circumstances if properly employed, and it is certainly 
much the best remedy for fever when trained nurses are on hand to 
administer it. Where only members of the family are in care of the 
patient, and the doctor can be on hand only once in twenty-four 
hours, it is manifestly difficult to resort to it. Nevertheless, the 
friends of the patient, if they are intelligent, can easily be taught 
how to use cold sponging with friction, and good results, far superior 
to those produced by antipyretic drugs, are thus obtained. The rea- 
sons for this are discussed further on. The water should be as cold 
as is necessary to reduce the fever satisfactorily in twenty minutes of 
sponging, and reaction must be produced by friction applied to the 



624 DISEASES. 

skin. This reaction is more important than the reduction of the 
fever. (See Cold in Fevers, Part III.) 

(For the use of guaiacol externally in fever, see article on Gruaiacol.) 

Sthenic Fevers. 

The application of antipyretic drugs to the febrile temperatures 
occurring in sthenic cases is not as irrational as their employment in 
a prolonged low fever of the adynamic type, but the wise physician 
will always endeavor to avoid their use if possible. Fever is not, as 
a rule, a very harmful process unless it is continued for a long period 
or is exceptionally high. Indeed it may even be beneficial. Anti- 
pyretic drugs decrease oxidation, probably interfere with ordinary 
protective natural efforts against disease, and place upon the eliminat- 
ing organs the task of excretion. In acute illnesses, if the use of 
cold is impossible, these remedies may be given, but usually it is 
unnecessary to employ them, for unless the fever is long continued it 
is not harmful in itself. In scarlet fever the use of such drugs should 
be avoided, because the kidneys are in danger. 

If in any case it is decided to give antipyretic drugs, they should 
never be pushed to the point at which even moderate cyanosis de- 
velops ; and if they do not control the fever in moderate dose they 
should be discarded and cold bathing insisted upon. 

Personally the w T riter never under any circumstances employs anti- 
pyretic drugs for the reduction of fever. 

In thermic fever, or sunstroke, the employment of antipyretics is 
often useless. The excessively rapid upward rush of the temperature 
responds in no way to drugs, and there are cases on record in which 
the use of antipyrin has utterly failed of good result. Thus, in one 
case reported by Singer a man suffering from thermic fever, with a 
temperature of 108 degrees, received 50 grains (3.3) of antipyrin hypo- 
dermically at 6 p. m. ; at 7 p. m. he received 10 grains (0.65) more 
under the skin ; at 8 P. M. 20 grains (1.3) more; and at 9.30 another 
20 grains (1.3) were used without effect. In other words, 100 grains 
(6.6) in three hours and a half proved useless. As directed in the 
;n tide on Sunstroke and Thermic Fever, the patient must receive cold 
baths and be bled. 

Asthenic Fevers. 

(Fevers of a Typhoid Type.) 

In the opinion of the author, antipyretics should not be employed 
in the reduction of the pyrexia of the typhoid state, our main reliance 
being upon cold applications. They ought never to be combined with 
the cold bath, ;is they prevent the one thing we seek in the use of the 
cold, namely, reaction. Aside from the fact that he has found such 
;in opinion well founded in a large number of eases, logical reasoning 
endorses its correctness. Even if antipyretics were perfectly innocu- 
ous, their constant use in fever would but give the already overstrained 



FHECKLES AND CHLOASMA. 625 

kidneys the task of their excretion, while the stomach, sufficiently 
disturbed by necessary medicines and illness, has enough to do without 
the addition of another load. Further than this, we know that these 
drugs are not perfectly harmless, and we also know that they depress 
the protoplasm of the body, and in consequence must gradually lose 
their power, which is not the case with the cold bath, which gains in 
power, The writer is sure that in typhoid and other low fevers of 
the continued type antipyretics should not be given. (For Brand's 
treatment, see Cold, Part III.) Fever will sometimes resist all doses 
of antipyretics we can give or all that it is safe to give, but no fever 
can completely resist the cold bath when properly used, for by its use 
we produce beneficial results by reaction even if an actual fall of tem- 
perature does not take place. In diseases of a more chronic type, 
particularly in those represented by phthisis, antipyretics are of doubt- 
ful value, owing to the increased sweating which is apt to be produced, 
and unless the patient seems to be particularly robust they should 
not be employed except in the smallest effectual doses and with great 
caution. 



FRECKLES AND CHLOASMA. 

The removal of freckles is readily accomplished, but their return 
is inevitable if any exposure to the sun or wind occurs. One of the 
best applications for their removal is a solution of corrosive sublimate, 
in water, varying in strength from 1 to 4 grains to the ounce (0.05-= 
0.2 : 32.0), and applied night and morning until the skin shows that 
it is irritated, when the lotion must be stopped for some days, after 
which its use may be begun again. A very efficient and much less 
dangerous remedy to leave about the room in which children are 
allowed to play is a saturated solution of boric acid in water, applied 
in the same manner as is the solution of bichloride of mercury. 

Another remedy is lactic acid, 10 grains to a drachm (0.65 : 4.0) 
of water, used in the same manner as the solution of the bichloride 
of mercury. The following prescription is recommended by Unna : 

R. — Bismuth oxidH __ , n A x 

Pulv. amyli } aa gr. xxx (2.0). 

Kaolini 5jj (4.0). 

Glycerini f^ij (8.0). 

Aquse rosae q.s. ad f§ij (64.0). — M. 

S.— Paint on spots and allow to dry, washing the drug off before each new appli- 
cation. 



Or the following may be used 

R. — Zinci oxidi .... 
Hydrarg. ammoniati 
01. theobromse . . 

Ol. ricini 

Essent. rosae . . . 
S. — Apply night and morning 
40 



gr. iij (0.2). 
gr. iss (0.08). 
f^ijss (10.0). 
f^ijss (10.0). 
gtt. x (0.65).— M. 



626 DISEASES. 



GASTRALGIA. 

The treatment of gastralgia may be divided into two parts — that 
directed to the relief of the attack when it is present, and that de- 
voted to the prevention of other attacks. During the acute stage 
hot applications and drinks, aromatic and locally stimulating warm 
infusions, a few drops of chloroform, or brandy or whiskey hot and 
concentrated, or 30 to 40 minims (2.0-2.65) of laudanum may be used. 
Counter-irritation often does good, and in some cases, particularly if 
a suspicion of an hysterical element exists, a vigorous revulsive may 
act Avith surprising success. Emesis and purgation are sometimes 
indicated, since in the early attacks the cause of the pain may be 
suspected to be the presence of indigestible food. 

The treatment required in the intervals between the attacks must 
vary with the cause and with the general condition of health. A 
careful search must be made for the real cause of the trouble, and 
when found it must be removed or palliated by appropriate measures. 

The diet should be carefully regulated, and all the hygienic details 
of the patient's life be critically studied and directed. The avoidance 
of improper food, the abandonment of tea, coffee, and tobacco, the 
prescription of proper dress, exercise, or change of residence, may be 
followed by marked improvement in general health and by a cessa- 
tion of the attacks of gastralgia. 

Any marked disturbance of digestion should be corrected ; and 
this may require the use of pepsin or of some tonic remedies, such as 
are suggested in the article on Indigestion. The chief reliance is, 
however, to be placed upon the administration of arsenic and iron 
immediately after meals, in proper form and doses. Thus, we may 
direct, 

R. — Liquor potassi arsenitis f^j (4.0). 

Viui ierri amari q. s. ad f^iv (120.0). — M. 

8. — From 1 to 2 drachms (4.0-8.0) in water after meals, three times daily. 



Or, 



R.— Tincture ferri chloridi f|j (30.0). 

Acidi livdroclilorici diluti 1 .. r - ,-,c ft \ *r 

Liquor acidi arsenosi f aa f 5 ss (15.0).-M. 

S. — From 4 to 15 minims (0.2-1. 0) in water after meals, three times daily. 



Occasionally even better results are secured by the use of cod-liver 
oil in emulsion with the hypophosphites. 

When the pain in the epigastrium is due to an excessive secretion 
of hydrochloric acid the various bromides are of value, and should be 
given Long enough before meals to permit them to produce their effects 
before the food enters the stomach. In other cases a pill of nitrate 
of silver and hyoscyamus should be employed. (See Gastric Ulcer.) 
Chloretone is also useful in the dose of 5 to 10 grains (0.30-0.65) in 
capsule. Ii is well, in cases where the pain is very severe, to com- 
bine with the above a powder of bismuth subnitrate and saccharated 
pepsin, given after meals. 

Constipation must be overcome by proper diet, massage, enemata, 



GASTRIC CATARRH, ACUTE. 627 

or by suppositories of gluten or glycerin or soap. If the use of bis- 
muth favors the continuance of constipation too decidedly, small 
doses of cyanide of potassium, dilute hydrocyanic acid, or chloroform 
may be substituted at the same hours. In cases where a highly neu- 
rotic state exists, it may be necessary to alternate all other treatment 
with the bromides or with the preparations of valerian, or the follow- 
ing prescription may be used : 

R. — Acid, hydrocyanic, dil . . - f.^j (4.0). 

Ext. carmab. indicse fl •"••.. f^j (4.0). 

Tr. hyoscyami f£j (4.0). 

Spt. chloroformi f^ij (8.0).— M. 

S. — 30 minims (2.0) t. i. d. in water for an adult. 

GASTRIC CATARRH (ACUTE). 

By far the most important point in the treatment of acute gastric 
catarrh is the regulation of the diet. The dietetics may be divided 
into two parts — first, the regulation of the food during convalescence 
or during the attack, and, secondly, the character of the food to be used 
during the interval following one attack and preceding the next. 
Total abstinence from food in the acute stages of the attack, and abso- 
lute bodily and mental quietude, are advisable. There are several 
reasons for this. In the first place, the juices of the stomach are in 
an abnormal state and unfit to act properly if the stomach receives 
more food. Secondly, the mucous membrane of the stomach is already 
hypersemic from the inflammation, and, as the normal viscus becomes 
physiologically hyperaemic on the ingestion of food, we would add to 
the congesticn of the blood-vessels did we allow more nourishment 
to enter the stomach. Last of all, the excess of the mucus and lactic 
and butyric acids present renders any new food impure before it can 
be assimilated, and so prolongs the trouble. As the attack passes 
oif small amounts of food may be given, which should be of a kind 
readily digested and not likely to become easily decomposed or ren- 
dered acrid by the mucus in the stomach. Milk with a large per- 
centage of lime-water is to be used, since the alkali not only pre- 
vents a too firm coagulation, but also decreases the secretion and 
acid reaction of the mucus. The thirst is often excessive, although 
anorexia is complete, and small pieces of ice may be administered for 
its relief. Small doses of bismuth subnitrate (grains 2 [0.1]) and of 
cerium oxalate (grain 1 [0.05]) every two hours are advisable. 

Commonly it will be found that the patient rapidly improves up to 
a certain point, then stops improving or relapses. This is sometimes 
due to an accumulation of mucus, which when mixed with food causes 
it to undergo fermentation. If marked evidences of the presence 
of this secretion are given, a mild and gently acting emetic may be 
employed to dislodge the fermenting mass. In other instances the 
relapses depend upon a tendency to a condition of atony, which can 
only be overcome by prolonged and careful treatment adapted to the 
improvement of the general health. Sodium bicarbonate with com- 
pound infusion or compound tincture of gentian may be used during 



628 DISEASES. 

convalescence, and small sips of effervescing draughts are useful. If 
constipation exists and vomiting forbids the use of the ordinary purga- 
tives, a Seidlitz powder divided into fourths or fifths, and taken in 
this way every fifteen minutes or half-hour, will settle the stomach, 
move the bowels, and often carry away mucus. 

If there is much epigastric distress, a spice poultice is often of 
service. 

Sweets and starches are to be rigidly denied the patient. If anae- 
mia exists, iron may be used, but this is rarely needed. 

The abdomen should be carefully protected with flannel, and 
draughts and unsanitary surroundings avoided. 

The use of pepsin and of hydrochloric acid is to be much more 
carefully resorted to than has heretofore been the custom. As a rule, 
we are apt to forget that pepsin acts largely by catalysis, and that it is 
not secreted as pepsin, but as pepsinogen, a substance which is changed 
into pepsin in the presence of an acid. For this reason hydrochloric 
acid should be employed after inflammation has passed away, and 
pepsin given in large or small quantity according as there is reason to 
believe this ferment to be in normal or abnormal amount. Common 
salt (sodium chloride) is often beneficial, and should be always used, in 
moderation, with the food. 



GASTRIC CATARRH (CHRONIC). 

Chronic gastric catarrh is a condition of the stomach commonly seen 
in a more or less well developed form. It is often associated with 
much indigestion and the eructation of sour liquids, or even with 
active vomiting. The secretions of the stomach are nearly always 
abnormal, and fermentative changes are constantly present in the gas- 
tric contents. Lavage is almost always to be resorted to for its relief. 
(See Part III. for Lavage.) 

By far the best treatment for this condition is the use of counter- 
irritation over the epigastrium by means of tincture of iodine, the close 
regulation of the diet, and the use, internally, of nitrate of silver and 
extract of hyoscyamus, and, if great hyperacidity exists, the admin- 
istration of the subnitrate of bismuth. Often, however, the better 
remedy is bicarbonate of sodium in the dose of 5 to 20 grains (0.35- 
1.3). In many instances the patient will be greatly benefited by the 
use of a Seidlitz powder or Carlsbad salt 1 orllunyadi or Apenta water 
before breakfast each morning, as this washes out the stomach, dis- 
solves the mucus, and unloads the mucous membrane of its congestion, 
at the Bame time overcoming any engorgement of the liver. Consti- 
pation is nearly always present, and should be relieved by appropriate 
drugs, such as the waters just named or cascara sagrada, of which the 
best preparation is the fluid extract, rendered free from bitter taste, 
a- in •' ( 'ascara Aromatic. " 

All hit.-, rich foods, strong meats, ham, bacon, or fried things are 

1 Artificial Carlsbad sail may be ordered, composed of 8 ounces of sodium sulphate, 
I .mi ounce "I sodium chloride, and 1 ounce of sodium carbonate. The dose varies 
from 2 drachms to £ an ounce (8.0-1 G.O). 



GASTRIC DILATATION. 629 

to be avoided, and only light broths, koumyss, or matzoon resorted 
to if the case be an obstinate or severe one. A nitrate-of-silver pill 
should be used half an hour before each meal, and be prescribed 
as follows : 

R. — Argenti nitratis gr. iv (0.2). 

Extract, hyoscyami gr. x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One, half to one hour before each meal. 

In cases in which the chronic inflammatory process has gone on to 
atrophy of the tubules the use of hydrochloric acid is often of great 
value. 



GASTRIC DILATATION. 

Gastric dilatation is to be treated with two objects in view, namely, 
the relief of the symptoms and the correction of the gastric condition 
as far as possible. The relief of the symptoms depends upon the proper 
regulation of the diet, the proper use of washing out the stomach 
(lavage), and the use of other remedial measures. All these efforts 
also tend to relieve or modify the underlying gastric state in that 
they remove certain influences which, if continued, w T ould necessarily 
make the condition of the patient worse. The actual state of dilatation 
when once developed cannot be materially improved. In the way of 
diet, all articles bulky in character, such as cabbage, and those foods 
which are slow of digestion and capable of rapid fermentation, should 
be excluded. Particularly is this true of rich or fatty foods, and of 
drinks such as beer and ale. When food is given, it is to be adminis- 
tered in small amounts and often, rather than in large, full meals, and 
it should consist chiefly of roasted and broiled meats, easily digested 
starches, such as " Zweibach " bread or "pulled bread/' and the 
green vegetables, like lettuce, asparagus, string beans, and moderate 
amounts of spinach. To aid in the digestion of vegetable foods full 
doses (2 to 4 grains) of taka-diastase should be taken with each meal, 
and to this may be added a little powdered capsicum, to stimulate the 
stomach. Where gastric digestion is very faulty, predigested food 
and rectal alimentation should be employed for a time. In the way 
of direct treatment, the stomach of the patient should be washed out 
with the stomach-tube at least once a day : and if fermentation 
is active and food is apt to be retained in this organ, it should be 
thoroughly cleansed before each meal, and some mild antiseptic, like 
boric acid, used in the washing fluid. Lavage not only removes 
decomposing food and mucus, but also exercises a beneficial effect on 
the gastric walls. The water used should not be cold nor tepid, but 
hot, and may contain 1 drachm (4.0) of boric acid to the pint (500 
cc). Faradic electricity applied to the epigastrium or to the stomach 
direct by a swallowed electrode is useful. In the w r ay of direct 
treatment by drugs, the physician should use full doses of dilute 
hydrochloric acid to aid digestion, say, 20 to 30 minims (1.3-2.0), and 
give strychnine in full doses to aid this function, and also to increase 



630 DISEASES. 

the motor power of the stomach, so that it will urge the food on into 
the bowel. Often the lavage, electricity, and strychnine combined 
will produce great improvement. General hydrotherapy in the form 
of cold douches to the entire body, and exercise on horseback or on 
foot, are very valuable in many cases. If fermentation is very marked, 
we may employ internally antiseptic substances, like beta-naphtol. 

GASTRIC ULCER. 

In the treatment of gastric ulcer three points must be borne in 
mind as being essential. These are, rest for the stomach as far as 
possible, rest for the patient, and the maintenance of the gen- 
eral health. The first of these points involves a consideration of 
diet. If in any case the stomach is very irritable, it is best to place 
the patient in bed and nourish her for from two to eight days by means 
of enemata. Probably the best form of nourishment for this purpose 
is a mixture recommended by Dreschfeld, and consisting of 2 raw 
eggs with 2 ounces (64.0) of beef-tea and a little brandy, which may 
amount to 1 ounce (32.0) if the patient really needs stimulants. It 
may be well to place a little pepsin in this injection to peptonize the 
proteids, but if this is done the alcohol must be left out, as it will 
interfere with the activity of the pepsin. Pancreatin may also be 
used with advantage in some cases in the amount of 5 or 10 grains 
(0.35-0.65) in each injection. Ewald of Berlin suggests the following 
nutrient enema : Beat up two eggs with a tablespoonful of cold water ; 
to this add a little starch boiled in half a cupful of a 20 per cent, solu- 
tion of grape-sugar and a wineglassful of red wine. The solution is 
to be well mixed at a temperature not high enough to coagulate the 
albumin, and injected as high up into the bowel as possible. For a 
child this mixture should be somewhat less in quantity than that given 
for the adult, particularly as to the wine. For the relief of thirst, 
which may be excessive if rectal alimentation is resorted to, the patient 
may hold in the mouth small pieces of ice or drink moderate quan- 
tities of cool barley- or ice-water ; but much thirst can be prevented 
by resorting to hypodermoclysis, whereby the body is supplied with 
plenty of fluid. After this treatment has been used for some days, 
small quantities of food may be given by the mouth, such as a little 
peptonized milk or a little warm milk with lime-water in the proportion 
of half and half, or 1 part of lime-water to 2 of milk. After this thin 
arrow-root or gruel may be given in moderate quantity, with taka- 
diastase to aid its digestion. It is better to give the food in small 
amount every two hours than in larger quantity three times a day. 
The increase in rations, both as to variety and amount, should be most 
gradual, the physician extending the dieting over at least six w T eeks, 
of which the first two had best he spent in bed. It is well to use 
massage and electricity under these circumstances to preserve nutrition, 
as in the rest cure. (See Rest Cure.) Beef-tea and soups had better 
ho avoided during the early Btages of the treatment, as they will irri- 
tate the stomach. Soft-boiled eggs, tender chicken or game, and 
minced lamb may he finally given. Oheese 3 coffee, tea. beer, and ale 



GASTRIC ULCER. 631 

are to be avoided, as are all hot drinks. Fresh green vegetables may 
be used in moderation, but fresh bread and unripe fruit must be care- 
fully avoided. When, milk is taken, it should be warmed. The 
presence of gastric pain indicates that the diet must be cut down in 
quantity and the nutrition maintained solely by rectal injection. 

The drug treatment of these cases is both palliative as to pain and 
curative. For the pain counter-irritation of a more or less severe and 
constant type should be applied to the epigastrium, either as a spice 
or mustard plaster or by means of a hot-water bag. The counter- 
irritation should be as continuous as possible. Sodium bicarbonate 
and the subnitrate and subcarbonate of bismuth are also of service in 
the dose of 20 grains (1.3) each, and to these may be added from 
-£q to ^ of a grain (0.003-0.015) of morphine hydrochlorate or 1 grain 
(0.05) of codeine. These may be given thrice daily if necessary. 
Only the smallest dose of morphine necessary to relieve the pain should 
be employed. A valuable treatment for the pain and for the ulcer 
itself is the following pill : 

R. — Argenti nitratis gr. iv. (0.2). 

Extract! hyoscyami gr. x vel xx (0.65-1.3). — M. 

Ft. in pil. No. xx. 
S. — One pill half to one hour before meals. 

Another useful drug in such cases is chloretone in 5- grain (0.35) 
doses given in capsules. "When great gastric acidity is present which 
is not controlled by the pill named above or by the use of chloretone, 
the following formula may be employed : 

R. — Sodii bicarbonatis 1 

Magnesia? ponderosse Y aa 5y (32.0). 

Calcii carbonatis j 

01. menthffi piperita? "n^ x (0.65).— M. 

S. — A saltspoonful every two hours in a little water. 

For the constipation which is frequently present the patient may 
receive a dose of Carlsbad salts or phosphate of sodium, or even the 
sulphate of magnesium, although it is best, as a rule, to rely upon the 
enema, which is used to wash out the bowel each day, and to produce 
a movement. 

For the relief of vomiting and of hgematemesis absolute abstinence 
from food, so far as its administration by the mouth is concerned, is 
to be insisted upon. Nutrition must be maintained, under such cir- 
cumstances, by feeding by the rectum with predigested food. (See 
Part III.) If the vomiting is persistent, small doses of cocaine, J 
grain (0.015), may be given, or cocaine and bismuth subnitrate com- 
bined. Sometimes drop doses of creasote are useful, or carbolic acid 
may be given in the same dose with 20 grains (1.3) of subnitrate of 
bismuth. One of the best remedies for hjematemesis is oil of turpen- 
tine in the dose of 5 to 10 minims (0.35-0.65) four times a day. In 
other cases good results will often follow the use of adrenalin chloride 
or of the solution of the subsulphate of iron (Monsel's solution) in the 
dose of 3 minims (0.15) every half-bour or by the employment of 3 
grains (0.15) of the salt itself in pill. Cold compresses or an ice-bag 
may also be applied to the epigastrium for the same purpose. 



632 DISEASES. 

Should perforation of the stomach occur, the prognosis is most 
gloomy unless inflammatory processes protect the peritoneal cavity, 
as often occurs. The tendency to peritonitis should be antagonized 
by the application of cold to the belly-wall, by the avoidance of food, 
by perfect physical rest, and by supportive treatment in the way of 
heat to the limbs and the hypodermic use of ether, brandy, or 
ammonia. Morphine should also be given freely unless collapse is 
too pronounced, as it tends to prevent abdominal pain and inflamma- 
tion. Operative measures may be resorted to in suitable cases. 

GASTRITIS (ACUTE). 

This is generally due to the ingestion of irritant foods or drinks, 
rarely arising in its true acute form from other causes. 

The treatment is to be directed entirely to the prevention of the 
spread of the inflammation and to the relief of that already devel- 
oped. If the patient is seen soon after the onset of the trouble, the 
stomach is to be emptied of all irritant substances by means of vom- 
iting induced by large draughts of warm water, or, better still, by the 
use of the stomach tube, as the retching may increase the irritation. 
Mucilaginous drinks are to be given freely, and albuminous materials 
seem especially useful. Oils and similar protective liquids aid in 
preventing further damage. Opium, to allay pain and the local and 
systemic irritation, is invaluable. This drug should always be given 
in liquid form, and the deodorized tincture is the best in this respect, 
owing to its freedom from narcotine. Paregoric contains too little 
opium to be of value, and is irritating because of its volatile oil. If 
the stomach will not retain drugs, they should be given by the rec- 
tum. If evidences of collapse appear, hot applications, atropine, or 
belladonna should be exhibited. It is important that the heat 
should be applied over the epigastrium and chest, and a flaxseed poul- 
tice is the best method of doing this. Practically, the same rules hold 
good in regard to diet in both acute gastritis and in gastro-enteritis. 



GASTRO-ENTERITIS. 

Gastro-enteritis is a condition of inflammation affecting the entire 
alimentary canal in some instances, and commonly produced by the 
ingestion of some irritant substance, either in the form of bad food, 
poisons, or mechanical irritants, such as grape-seeds or cherry-stones. 
The symptoms accompanying it are exceedingly various, but consist 
chiefly in pain of a griping character with watery or mucous stools, 
or. if the inflammation be very severe, absolute and unyielding con- 
Btipation may be present. The nervous symptoms depend upon the 
degree of irritation and the general nervous tendency of the patient, 
and if tin; trouble is very severe he may go on into a condition of 
shoek or collapse. 

If i he iiriiation is very intense, exfoliation of the mucous raem- 
brane may take place, the epithelium coming away in shreds. 

The treatment of gastro-enteritis depends upon its severity and 



GLA UCOMA—GONOBRHCEA. 633 

cause. Almost always we first allay the pain and tendency to inflam- 
mation by the hypodermic use of morphine, and immediately follow 
this or precede it by an emetic of a non-irritating and rapidly acting 
type, such as apomorphine, provided there is reason to believe that 
the poison or food still remains in whole or in part in the stomach. 
If the irritant has been taken some time before the physician is called 
in to see the case, emetics are -contraindicated, as by disturbing the 
abdominal contents they render the inflammation worse. If the irri- 
tant has already passed through the pylorus, castor oil in the dose of 
2 to 3 tablespoonfuls (30.0-45.0) to an adult may be given to sweep 
out the offending materials and lubricate the intestinal walls. In 
other cases sulphate of magnesium is to be used in preference to sul- 
phate of sodium or Rochelle salt, as they are both slightly irritant. 
The sulphate of magnesium is of value, because, in addition to its 
purgative effect, it also depletes the inflamed bowel. Having got rid 
of all offending materials, opium is to be freely used to allay irrita- 
tion and control diarrhoea (see Diarrhoea), and hot compresses are to 
be applied to the belly, or a spice or mustard plaster used instead. 
Vomiting when it is excessive is to be treated in the manner described 
under that head. The after-treatment of acute gastro-enteritis is very 
important, both in respect to food and drugs. Predigested foods are 
therefore in many cases indispensable, and a carefully regulated diet 
is a sine qua non. The abdomen should be protected from cold by a 
flannel binder. 



GLAUCOMA. 

Glaucoma, or that disease dependent upon an increase of intra- 
ocular pressure, appears in an acute or a chronic form. The disease in 
general terms is characterized by halos appearing about the gas-light ; 
periods of obscuration of sight ; shrinking of the nasal half of the 
field of vision ; narrowing of the anterior chamber of the eye : anaes- 
thesia of the cornea ; and increased tension of the eyeball. In the 
"glaucomatous attack," or acute glaucoma, the injection of the eye- 
ball is intense ; the lids swell, there is photophobia, the cornea is 
steamy, the pupil dilated and motionless, and the vision rapidly 
destroyed. The case may be mistaken for iritis or acute ophthalmia 
— a fatal blunder. 

Iridectomy or an equivalent measure is the only treatment for 
glaucoma. If for any reason this is delayed, a solution of the sul- 
phate of eserine, 1 to 2 grains to the ounce (0.05-0.1 : 32.0), or pilo- 
carpine nitrate in twice this strength, should be dropped into the eye 
every two or three hours until relief follows. Atropine must not be 
employed. Hot compresses, opiates, and leeches are also useful to 
alleviate the pain if for any reason operation is delayed. 

GONORRHOEA. 

The therapeutics of urethritis varies in accordance with whether 
the disease is acute or chronic, and is very greatly modified by the 



634 DISEASES. 

seat of inflammation — a posterior urethritis, for anatomical and 
mechanical reasons, not being amenable to the same treatment which 
will prove successful when the disease is limited to the penile portion 
of the urethra. 

The membranous and prostatic portions of the urethra constitute 
its posterior part. They are surrounded by layers of powerful mus- 
cles which keep the canal constantly occluded and which play the 
part of vesical sphincters. Hence any injection forced into the 
urethra passes to, but not beyond, its membranous part, and is worse 
than useless if administered with the intention of combating inflam- 
mation of the posterior urethra. It is the rare exception for gonor- 
rhoea to be confined to the anterior urethra. Usually it extends back, 
and a common cause of gleet is failure to recognize this fact, and con- 
sequently the omission of measures calculated to cure the deep inflam- 
mation. 

Since the general acceptance of the gonococcus as a specific cause 
of gonorrhoea the treatment of acute anterior urethritis has been 
mainly antiseptic, those drugs being chosen which are found to act 
most powerfully upon the specific germ, and at the same time pro- 
duce the least irritant action upon the mucous membrane. Bichloride 
of mercury, as representing the most powerful germicide known to 
medicine, has been used extensively. The main objection to its action 
lies in the fact that when employed in efficient strength it is exceed- 
ingly irritating. Potassium permanganate, though of less antiseptic 
power, is therefore preferred. A fairly satisfactory treatment consists 
in thoroughly and repeatedly flushing the urethra with permanganate 
lotion, 1 : 6000 . This may be accomplished by means of a fountain- 
syringe and a blunt, flattened, conical nozzle of such size that when 
its extremity is passed into the meatus its sides will be grasped so 
tightly that gentle pressure upon the nozzle will prevent regurgitation 
of fluid. The bag is filled with hot permanganate solution, 1 : 6000, 
and is elevated six feet above the level of the bladder. After first 
thoroughly washing the glans and lips of the meatus the nozzle should 
be inserted and held firmly in place until the entire anterior urethra is 
distended, when the nozzle should be slightly withdrawn and the 
urethra contents allowed to escape. After this has been repeated 
several times the nozzle is held firmly in place till 3 or 4 ounces of 
solution have passed into the bladder. This treatment should be 
repeated night and morning for at least a week, the strength of the 
permanganate solution being gradually increased up to 1 : 2000, if 
undue irritation is not caused by such increase. If at the end of a 
week no gonococci can be found, the irrigations should be continued 
once daily for four days, supplemented by astringent injections. When 
gonococci persist the irrigations should be continued for two or three 
weeks. When this method of irrigation cannot be practised, a syringe 
with a conical nozzle and with a capacity of at least 1 ounce may be 
employed : this should he used two to six times a day, two syringefuls 
-»{' the dilute lotion being injected immediately after urination. The 
Liquid should he forced in very gently, being allowed to flow out by 
slightly Lessening the pressure of the nozzle upon the meatus when the 



GONORRHCEA. 635 

anterior urethra is full. When large injections are attempted by the 
ordinary small urethral syringe, the frequent application of the latter 
to the meatus occasions much irritation. It is desirable that the 
injection should pass back into the posterior urethra, since this por- 
tion of the canal is usually involved in acute inflammation. 

Copious irrigations inaugurated in the earliest stages of gonorrhoea 
are frequently successful in producing a complete cure in a few days. 

The following prescription used as a hand-injection is among the 
most efficacious in checking the discharge : 

R. — Nargol or protargol gr. iij (0.15). 

Aquas destil giij (90.0).— M. 

S. — Use locally in the subsiding stage. 

R — Ext. hydrast (colorless) f^iv (16.0). 

Bismuth, sublact. £vj (24.0). 

Glycerin f^iv (16.6). 

Aq. destil q. s. fjvj (180.0).— M. 



h. ) 

)0l. [ 

id. J 



R. — Zinc, sulph 

Acid, carbol. \- aa gr xij (1.0). 

Alum. crud. 

Aq. destil fgvj (180.0).— M. 

S. — Locally. Dilute if painful. 



When the gonorrhoea has already assumed a markedly inflamma- 
tory type, with swelling and oedema of the penis, redness and ever- 
sion of the meatus, and great sensitiveness of the urethra, and seems to 
be aggravated by mild irrigations, the penis should be wrapped in 
cloths kept wet with alcohol and water or lead-water and laudanum. 
With the subsidence of acute inflammatory symptoms and the appear- 
ance of copious discharge the inj ection treatment may be inaugurated. 
It must be remembered that injections may in themselves prevent 
the discharge from entirely disappearing. Hence, as the symptoms 
ameliorate the injection should be made less frequently, finally being 
entirely omitted for some days if the discharge seems to continue 
longer than usual. 

Internal medication and constitutional treatment are most import- 
ant in all forms and stages of gonorrhoea. It is almost universally 
accepted that certain drugs, such as copaiba, cubebs, and oil of san- 
dalwood, when eliminated through the kidneys, possess the power of 
inhibiting the growth of the gonococci or of destroying their vitality. 
Bacteriological research has shown that of this class of remedies 
copaiba alone possesses such power. To this drug may be added 
salol, which has been proved by laboratory and clinical tests to exert 
a powerful germicidal action upon the gonococcus. Clinical experience 
has shown that oil of sandalwood is of great value in the treatment 
of chronic gonorrhoea. An excellent formula for the administration of 
balsams is the following : 

R.— 01. santal gr. v (0.3). 

Balsam copaibse n\,v (0.3). 

01. cinnamom TT^j (0.05). — M. 

Encapsulate. 
These capsules should be taken one hour after meals, from six to twelve being admin- 
tered a day. 



636 DISEASES. 

Obstinate chordee may require bromide of potassium and chloral. 
Of these a drachm of the former must be given at bed-time, and 10 
grains (0.65) of the latter ; this may be repeated in the night if painful 
erections persist. Lupulin in 30-grain (2.0) doses is also endorsed. 
When practicable, opium or belladonna suppositories, or hypodermic 
injections of morphine gr. \ (0.015) and atropine gr. -^ (0.001), will 
prove very satisfactory. In all cases the patient should be instructed 
to take a prolonged hot bath before going to bed, and to rise once 
during the night and pass his water. 

Ardor urinse is usually relieved by the use of demulcent drinks 
and by the employment of bicarbonate of sodium or citrate of potas- 
sium in sufficient doses to render the urine but slightly acid. Either 
of these drugs is conveniently administered in the form of compressed 
tablets, taken one or two hours after meals in 10-grain (0.65) doses, 
the quantity being increased, if necessary, until the desired effect is 
produced on the urine. The instillation into the urethra, by means 
of an eye-dropper, of a 4 per cent, solution of cocaine a few minutes 
before urination markedly diminishes the burning. Finally, this 
symptom may often be relieved by instructing the patient to pass his 
water with the penis submerged in a vessel containing water as hot as 
can be borne. 

Where the inflammation is of a high grade and attended by fever 
and general malaise, the administration of 2 minims (0.1) of aconite 
repeated every two or three hours is followed by marked relief. 

In regard to the general treatment of a patient suffering from 
gonorrhoeal urethritis rest in bed is particularly desirable. This, 
however, is rarely possible, and the surgeon must be content with 
enforcing the avoidance of all active exertion and the observance of 
as much rest of mind and body as is compatible with the continuance 
of the daily routine of business life. While skimmed milk or butter- 
milk diet is theoretically desirable, the advantages to be gained by 
it are scarcely sufficient to justify insistence upon such a regimen, 
especially as it would excite suspicion as to the presence of venereal 
disease ; hence a light diet, consisting mainly of vegetables and fruits, 
and in quantity about half that usually taken, with a minimum amount 
of meat, should be advised. In addition the patient should be induced 
to drink liberally of plain water or any of the sparkling mineral 
waters, as by this means the urine is not only rendered bland, but 
greatly increased in quantity, thus enabling the urethra to be fully 
flushed from behind many times a day. Flooding of the stomach 
with such large quantities of liquids as to produce dyspepsia is to be 
carefully avoided. It is scarcely necessary to state that copulation or 
any form of venereal excitement must be strictly interdicted. Finally, 
prolonged warm baths lasting from half an hour to two hours seem 
t<» exert a favorable influence upon local inflammation. 

The distressing symptoms of acute posterior urethritis do not usually 
develop until the disease of the penile portion of the urethra has run a 
course of two or three weeks. During the very acute symptoms local 
treatment applied to any portion of the urethral canal probably aggra- 
vate- the condition, and even the internal administration of balsams 



GONORRHOEA. 637 

and antiseptics must be employed with very great caution, there use 
being suspended at once if the inflammation seems to be aggravated. 
Hence, when in the third week of gonorrhoea there is a violent out- 
break of inflammation in the membranous and prostatic portions of 
the urethra, suspension of all active treatment is indicated. The 
bowels are kept open ; the diet is carefully regulated ; the urine is 
rendered bland, unirritating, and antiseptic ; repeated warm baths are 
ordered, the painful symptoms being controlled by opium and bella- 
donna, administered either hypodermically or in the form of a supposi- 
tory. When the acute symptoms subside the quantity of antiseptics 
taken by the mouth may be increased, balsams may be added, and 
local treatment may be directed first to the posterior urethra, after the 
cure of which the anterior urethritis should receive attention. It has 
been stated already that injections forced into the meatus rarely pene- 
trate beyond the bulbous portion of the urethra; hence to influence 
the deeper portions of this canal some other method of applying 
drugs must be devised. This end is best accomplished by means 
of the gravity-bag and meatus nozzle or Ultzmann's irrigation 
catheter. 

The patient is first instructed to empty the bladder of a portion of 
its contents ; by this means the urethra is flushed out. The catheter 
is then introduced into the membranous portion of the canal, and by 
means of a syringe 1 ounce (30.0) of the injection is forced into the 
membranous and prostatic portions of the urethra. This fluid enters 
the bladder, and is passed with the urine at the next act of micturition. 
The injection most employed is the following : Nitrate of silver, grain 
i to 1 (0.015-0.05), distilled water, £j (30.0). Any of the injections 
used in anterior urethritis may also be now employed. These injections 
should be made every other day. 



Chronic Gonorrhoea. 

Chronic gonorrhoea differs from the acute form in the fact that the 
inflammation is distinctly localized in certain portions of the urethra, 
and does not invade the whole canal with uniform intensity ; hence, 
efficient treatment must be directed not to the whole urethra, but to 
the diseased areas. Foci of chronic urethritis are usually found 
either in the bulbous portion of the urethra or in the membranous or 
prostatic portion. If the disease is located in the anterior urethra, 
it will commonly be found to depend upon the existence of a stric- 
ture of large calibre. The passage of sounds of full size — cutting 
the meatus if this is necessary for their introduction — will be followed 
by prompt relief in such cases. The sounds should be used not more 
frequently than twice a week, and should be most carefully sterilized 
before introduction. 

If after free dilatation the discharge still persists and a large por- 
tion of the anterior urethra is in a catarrhal condition, as shown by 
examination of the urine, irrigation of the urethra should be prac- 
tised. This may be best effected by the gravity-bag and short urethral 



638 DISEASES. 

nozzle, irrigating daily with nargol or protargol (1 : 3000 to 1 : 500), 
silver nitrate (1 : 1000), mercurol (1 : 2000), or potassium permanganate 
(1 : 2000 to 1 : 500). When the general catarrhal condition is 
materially modified, by means of an ordinary hard-rubber endoscope 
and a head-mirror the focus of inflammation may be exposed, and may 
be treated directly by strong astringent solutions carried in by means 
of a brush or by absorbent cotton secured to the extremity of a long 
applicator. Nitrate of silver or sulphate of copper, 20 grains to the 
ounce (1.3 : 30.0), may be employed. Unna has devised a most success- 
ful treatment for obstinate cases of gonorrhoea. He advises coating 
the sounds with the following mixture : 

R.— 01. cocae ^iij (90.0). 

Cera flav &ss (2.0). 

Argent, nitratis gr. xv (1.0). 

Balsam. Peruvian ^ss (2.0).— M. 

This is liquefied in a water-bath ; the sounds are dipped in it and are 
then hung up to dry. On being passed the heat of the body melts 
the coating. The objection to their use lies in the fact that the appli- 
cation is made to the entire urethra. Practically, however, their 
employment is often followed by brilliant results. 

Chronic posterior urethritis must be treated by remedies applied 
directly to the diseased area. The silver salts are more commonly suc- 
cessful than any other medication. By means of Ultzmann's instillator 
5 to 10 minims (0.3-0.65) of a solution varying in strength from 0.1 
per cent, to 5 per cent, may be employed. Irrigations are also ser- 
viceable ; but previous to their employment the prostatic follicles 
should be emptied of their purulent contents by massage through the 
rectum. 

Finger recommends the following ointment : 

H. — Argent, nitratis vel cupri sulph gr. xv (1.0). 

Lanolin ^iij (90.0). 

Ol. olivae 3jss (6.0).— M. 

By means of an ordinary catheter — which is first filled, then intro- 
duced until its eye reaches the prostatic portion of the urethra — a 
definite quantity of the ointment can be forced into the canal by a 
graduated rod. 

In many cases pressure will exert a curative action, causing prompt 
absorption of inflammatory effusion. To accomplish this result large 
sounds may be passed into the bladder. Frequently the therapeutic 
influences of cold, together with pressure, are found beneficial. The 
best means of combining these two remedies is found in the psychro- 
phore, an instrument in the shape of a sound, but so arranged that a 
Stream of water Hows through its interior. 

It must be borne in mind that chronic gonorrhoea is commonly due 
to unskilful or doI sufficiently prolonged treatment of the acute stages. 
Not only should the treatment of acute gonorrhoea be continued until 
the gonococci have entirely vanished, but for fully two weeks after 
the disappearance of all symptoms of inflammation. The same rule 



GONORRHCEA. 639 

holds good in regard to the chronic manifestations of the disease. 
Only after careful examination of the urine fails to show any sign of 
inflammatory trouble for at least two weeks should the treatment be 
suspended ; and this should not take place suddenly, but the intervals 
between the applications be gradually increased in length, the patient 
being carefully watched in the mean time. 

Per contra, it must not be forgotten that long-continued irritant 
treatment may in itself indefinitely prolong a urethral discharge. 
Hence it is wise to suspend all injections in certain cases, and to 
examine the discharge carefully, as found in the urine, to determine 
whether or not the continuance of symptoms is dependent upon this 
cause. 

There is a mucous secretion which quite frequently follows gonor- 
rhoea, but which is in no way dependent upon the persistence of this 
disease. Microscopic examination will at once determine its nature. 
It is probably most rapidly cured by attention to general hygiene and 
by tonic and supporting treatment. 

Complications of Gonorrhoea. 

Among the many local and general complications which may occur 
in the course of an acute or subacute gonorrhoea are balanitis, balano- 
posthitis, prostatitis, and epididymitis. 

Balanitis and balano-posthitis are treated by perfect cleanliness. 
The discharge must be thoroughly washed out, and the surface must 
be dried and isolated. The thorough cleansing of the parts is best 
accomplished by weak astringent solutions, such as the chloride of 
zinc, 4 grains to the ounce (0.2 : 30.0), 1 per cent, boric acid, or 1.5 
per cent, carbolic acid ; nitrate of silver is particularly valuable, and 
in the proportion of 1 grain to the ounce (0.05 : 30.0) will be found 
sufficiently strong for use as a wash or injection. The superficial 
ulcerations may be further touched with the solid stick of the nitrate 
of silver. The prepuce having been retracted and the parts having 
been thoroughly washed, dusting powder, such as tannin or oxide of 
of zinc, is distributed over the surface of the inflamed parts ; the glans 
is then covered with a thin layer of absorbent cotton and the prepuce 
drawn forward. This dressing is to be repeated three times daily. 

If the phimosis is so tight that the prepuce cannot be retracted, 
cleansing, astringent injections, and wrapping the penis in one or 
two thicknesses of gauze or other thin fabric, constantly kept wet 
with dilute lead-water, will be the treatment indicated. If, in spite 
of this treatment, inflammatory symptoms become more marked, split- 
ting up the foreskin or circumcision is indicated. 

Prostatitis is a rare complication, and in its early course presents 
the symptoms of posterior urethritis. Where the acute symptoms are 
fairly developed direct local treatment is of little avail. Rest in bed, 
light diet, careful regulation of the bowels, medication to render the 
urine bland and unirritating, elevation of the pelvis, local depletion 
by means of leeches applied to the perineum, rectal ice-bags, and the 
administration of morphine and belladonna, either by means of sup- 



640 DISEASES. 

pository or by hypodermic injection, represent the general treatment 
of all inflammatory conditions at or about the neck of the bladder. 
In the great majority of cases prostatitis undergoes prompt resolution, 
and this is more powerfully influenced by rectal injections than by any 
other method of treatment. For this purpose a two-way rectal tube 
must be employed, the nozzle of which is directed against -the pro- 
jection of the prostate into the bowel. From 2 to 4 quarts (2 to 4 
litres of normal saline solution, either very cold or as hot as can be 
borne, are allowed to flow into the rectum by gravity, this arrange- 
ment of the tubes allowing the injection to flow out as rapidly as it 
flows in. This treatment should be repeated three or four times a day. 
When, in spite of careful treatment and the free use of anodynes and 
antispasmodics, there is retention of urine, a soft catheter should be 
passed into the bladder and allowed to remain there. 

If general and local symptoms denote abscess-formation, the pus 
should be evacuated by perineal incision as soon as its presence is 
positively determined. It is true that the pus collection usually is 
spontaneously discharged into the urethra, but this result cannot cer- 
tainly be depended upon, and, at best, is an unsatisfactory termina- 
tion of the trouble. 

When the inflammation runs into a chronic type, the treatment 
suitable for chronic posterior urethritis is indicated — namely, the use 
of large cold steel sounds, massage, and local applications to the 
prostatic urethra. In addition rectal injections, by means of the two- 
way tube, are very efficient in producing a cure. 

Epididymitis requires rest in bed, cessation of all irritating local 
treatment directed against the gonorrhoea, the elevation of the pelvis 
and testicles, and the systemic treatment applicable to acute inflamma- 
tion. The general tendency of this complication of gonorrhoea is to- 
ward spontaneous resolution. The testicles may be supported by a hand- 
kerchief bandage, the base of which is passed beneath the scrotum, 
while the ends and apex are secured in front to a circular band pass- 
ing about the waist. To combat the agonizing pain and hasten the 
cure punctures have been advised. These, by relieving tension, 
promptly alleviate the suffering. Ice-bags may also be applied, 
though it is claimed that as a result of this treatment there remains 
an obstinate induration of the epididymis. Local applications of the 
nitrate of silver, guaiacol, and of tincture of iodine are also said to act 
beneficially. 

Since it is usually impossible for a patient suffering from gonor- 
rhoea! epididymitis to keep to his bed, a treatment must be devised 
which will allow him to attend to his business, and at the same time 
will prevent the inflammation from becoming aggravated. The part 
must be splinted; if at the same time uniform pressure can be applied 
the cause «'f" the trouble will be still further favorably modified. 
These indications are complied with, partially at least, by strapping 
the injured testicle. For this purpose a number of adhesive resin 
Strips, each half an inch wide and long enough to pass three-fourths 
around tie' swelled testicle, are cut. The first strip encircles the 
scrotum between the affected testicle and the body, tightly imprison- 



GONORRHEA. 641 

ing the former in a pouch of skin. The succeeding strips are then 
placed, each overlapping the other in such a manner that the entire 
pouch is covered in, and a handkerchief bandage, applied as described 
above, may then be used to elevate the testicle. A better means of 
securing rest and pressure, and at the same time exerting the resol- 
vent influences of heat and moisture, is offered in the dressing pro- 
posed by Horand-Langlebert. The entire scrotum is first enveloped 
in a thick layer of cotton ; over this is placed a piece of rubber-dam 
sufficiently large to cover in the cotton, and the dressing is completed 
by an ordinary suspensory, gored at the sides and provided with tapes 
to allow of close fitting. Unless there be decided swelling of the 
spermatic cord, this dressing usually allows the patient to attend to 
his business, and is followed by as prompt resolution as though con- 
finement to bed had been insisted upon. 

When the acute symptoms have disappeared attention must be 
directed to the removal of infiltration, which if it persists may be a 
cause of sterility. This is accomplished by the continuance of heat, 
moisture, and pressure ; by local applications, such as iodine gr. iv 
(0.25) in lanolin ^j (30.0), or of equal parts of mercury ointment and 
belladonna ointment, or by ichthyol, with lard half and half, and by 
the internal administration of iodide of potassium, 5 to 10 grains 
(0.3-0.65) three times daily. 

Gonorrhoea in the Female. 

The symptoms of acute gonorrhoea in the female are usually so 
mild that the attention of the physician is rarely called to the disease 
until it has reached its chronic form and has invaded the uterus and 
its appendages. When, however, acute urethritis is found, the treat- 
ment, both local and general, is conducted on the same principles as 
when the disease attacks the male urethra. During the most acute 
stage no local treatment is advisable, but subsequently injections can 
be made with the ordinary hard-rubber syringe, not more than a 
drachm and a half of the liquid being employed at a time. If the 
urethral discharge persists, the seats of the suppuration are readily 
found by the endoscope tubes, and treated directly by applications of 
strong solutions of nitrate of silver or sulphate of copper. The 
results of treatment are commonly satisfactory. 

Acute vaginitis is not very frequently observed, excepting in chil- 
dren and young girls. In addition to the general treatment of inflam- 
mation, local treatment directed to cleansing thoroughly the inflamed 
surfaces of discharge and acting upon them by a strong antiseptic 
lotion will be followed by a rapid cure. The patient is instructed to 
irrigate the vagina three times daily with 2 pints (1 litre) of bichlo- 
ride-of-mercury solution, 1 : 4000, thrown in by means of a fountain 
syringe. For this fluid to reach every portion of the diseased mucous 
membrane it is necessary that the patient should lie upon her back 
with the hips elevated. Before rising a pledget of absorbent cotton 
is placed between the labia. During the most acute stage of vaginitis 
hot-water injections and prolonged hot sitz-baths are indicated. In 

41 



642 DISEASES. 

addition to the antiseptic irrigations which the patient is directed to 
make, the physician should every second day insert a speculum and 
paint every portion of the diseased mucous membrane with nitrate- 
of-silver solution varying in strength from 4 to 40 grains to the ounce 
(0.25-2.65 : 30.0). The vagina should then be packed with tampons 
of absorbent cotton, which may be dusted with astringent medicaments. 
Vulvitis corresponds to balanitis in the male, and is treated in a 
similar manner. Cleanliness is the most essential point in securing 
a cure. The parts are thoroughly washed with weak antiseptic 
lotions, and the abraded mucous surfaces are kept from coming in 
contact by means of a layer of absorbent cotton or a piece of lint 
soaked in dilute lead-water or other mild astringent solution. 

GOUT. 

Gout is a word used to signify a series of manifestations occurring 
chiefly in those who have led a lazy, sluggish life and have lived 
on the fat of the land, and partaken more frequently of alcoholic 
beverages than of water; or it occurs in persons who do not live in 
this way, but whose ancestors will be found to have done so, and to 
have handed down to them the gouty taint or diathesis ; or, once 
more, in those who have had poor food for a long time. In other 
words, it is a disorder of nutrition and metabolism. Very few 
Americans have gout in its marked and characteristic forms, owing 
to the active life they pursue, and to the fact that the inhabitants of 
the Western hemisphere drink large amounts of water, thereby contin- 
ually dissolving effete matters in the system and washing them away. 
Nevertheless many Americans suffer from what may be called lithseruic 
symptoms, which are due to lack of exercise, overeating, and perverted 
metabolism. 

The therapeutic importance of pure water in this state is remark- 
able, and the so-called lithia waters depend for their value more upon 
their freedom from lithium than upon their presence. When a patient 
goes to medicinal springs, by continually drinking water he Avashes 
out the kidneys and prevents deposits of effete matters throughout 
the body. In a gouty individual the liquids of the body may be 
said to be so overladen with salts that they deposit them wherever a 
spot is found which is easy of access, just as water laden with lime 
forms a deposit on the sides of its bed when a drought comes on, and 
dissolves and removes these formations when a freshet takes place. 
\ <ty often, when such waters are not attainable, satisfactory results 
will be reached by ordinary distilled water, the insipid taste of which 
can be overcome by charging it with carbonic acid gas. 

W hen an acute attack of gout comes on, it is generally situated, as 
is well known, in the joint of the big toe or other toes, but it may 
involve any part of the body, even to the heart and the abdominal 
viscera. By far the best remedy for the relief of the pain is mor- 
phine, which should be given hypodermically. At the same time the 
besl remedy foi goul that we have, colchicum, should be freely given 
until the patient shows the full effect of the drug, as evidenced by gas- 



GOUT. 643 

tro-intestinal discomfort or pain and slight laxity of the bowels. The 
drug should be used in the form of the wine of the root, not that of the 
seeds, in the dose of 20 minims (1.3) at first, and increased by 1 minim 
(0.05) every four hours until relief is obtained or symptoms of over- 
dose appear as noted above. In other instances the method of admin- 
istration suggested in the article on Colchicum may be resorted to. 

The local treatment of gout, when it is active, consists in the appli- 
cation of a number of remedies. For hospital practice a very useful 
mixture is made by adding 1 part of bicarbonate of sodium to 9 parts 
of linseed oil. The joint is then wrapped in a piece of lint soaked 
with this concoction. In other cases collodion may be applied in one 
or two good coats, not more, with relief, and in still others oil of pep- 
permint has been recommended. It is to be remembered, however, 
that the inflamed joints are not to be treated by depletion through 
leeches or bleeding, as by this means they ultimately become worse ; 
or, in other words, the treatment of gouty inflamed joints is not iden- 
tical with that of inflamed joints from other causes. When the pains 
of acute gout are very severe at night, potassium iodide, in the dose of 
15 grains (1.0) at four or five o'clock in the afternoon, will sometimes 
give relief; this drug should always be combined with colchicum if the 
disease is subacute or chronic. 

In chronic gout, except during the acute exacerbations of the dis- 
ease, colchicum is almost useless, but potassium iodide should be 
pushed to the point of iodism if the trouble be painful. Here diet 
comes in for a great part of the treatment, and should consist of 
foods which are not fatty nor rich, but plain and nourishing. Milk 
and eggs, the white meat of chicken, and fruits cooked without sugar 
being added are allowed, tea and coffee being used only in modera- 
tion. If any wine is taken, it must be followed by copious draughts 
of pure water, and this last article should be used ad libitum. On 
the other hand, pastries, and, more than all, sweet wines, are the 
worst things that such a patient can take, and must be absolutely 
prohibited. 

The insomnia of chronic or subacute gout is best put aside by 
potassium bromide and chloral, the former drug being the safest and 
best. 

Nothing should be done in the neighborhood of gouty joints which 
will injure the skin, as it is easily disorganized and its injury may lead 
to erysipelas. Where the deposit around the joints is very great and 
the normal movements are impossible, relief is often obtained by the 
application of a solution of citrate or carbonate of lithium, 5 to 10 
grains to the ounce (0.35-0.65 : 30.0) of water, on lint wound around 
the parts. Where the skin is broken and will not heal, this treat- 
ment often permits healing by dissolving the crystals in the wound 
which prevent the approximation of the edges and so cause local 
irritation. 

Iodine ointment or the tincture of iodine is often placed around 
chronic gouty joints with advantageous results. 

A standard remedy in subacute or chronic gout is arsenic, and its 
administration in the form of 3 minims (0.15) of Fowler's solution, 



644 DISEASES. 

with either perfectly pure or lithiated water, is always to be resorted 
to. If anaemia is present, arsenic is particularly indicated, and cod- 
liver oil and syrup of the iodide of iron are also of value in this 
state. 

We find, therefore, in conclusion, that the use of large amounts 
of pure water devoid of salts, and the administration of colchicum. 
potassium iodide, and arsenic, are the greater points about which the 
rest of our treatment should centre. In those cases where retrocedent 
gout comes on the heart must be supported by stimulants, particu- 
larly by hypodermic injections of ether until the slower drugs can 
act. by heat over the belly, by the use of opium to allay irritation, 
except when the brain and kidneys are seriously affected, by the use 
of diuretics and alkaline drinks, and finally by counter-irritation in 
the shape of a mustard plaster placed over the abdomen or chest as 
the case may require. 

HEADACHE. 

(For Neuralgic Headaches, see Neuralgia; for Bilious Headache, 

see Biliousness.) 

Probably no single source of pain compares in its frequency to 
headache, chiefly because it is essentially a symptom of many dis- 
eased processes or functional disturbances. It may arise from con- 
stipation or eye-strain, from brain disease, from anaemia, from uraemia, 
from plethora, from nervous breakdown, and from a multitude of 
causes which, if they were all recounted, would cover many pages of 
this book. 1 In many instances the employment of a mild laxative, 
which will cause the bowel to empty itself thoroughly, is a necessity. 
In others a careful measurement of the amount of urine passed in the 
twenty-four hours will show that the urinary secretion is deficient in 
liquids and solids, so that effete and poisonous materials are retained 
in the blood, which produce headache. For such cases the frequent 
use of Vichy water (Celestins Spring), to which is added a little 
bicarbonate of potassium as a diuretic, will prove of great service. 

Congestive headaches, dependent upon an engorgement of the cere- 
bral vessels with blood, are to be treated in a number of ways, and if 
any direct cause of congestion can be discovered, this must, of course, 
be removed. So far as the direct application of drugs is concerned, 
wo find two methods of promoting a cure. The first consists in the 
use of ergot, which will cause contraction of the dilated vessels; the 
ad, in the employment of vascular sedatives, which will produce 
arterial depression and so remove congestion. Sometimes one of 
these methods will succeed where the other fails, and it is almost 
impossible to loll beforehand which case should have one drug and 
which another. It is to be remembered that when the congestion is 
due to vascular relaxation and weakness the vascular sedatives are 
contraindicated. 

The ase of a hot mustard foot-bath is of great value and a mus- 



HEADACHE. 645 

tard plaster or dry cup applied to the nape of the neck is often of 
service in congestive headaches, while in severe cases an ice-bag applied 
to the head or leeching behind the ears or on the temple may be re- 
sorted to. Bleeding often gives relief at once in severe congestive 
headache. 

In nervous women who suffer from headache much comfort and 
relief will often ensue if the top of the head be wet with one of 
the following formulae : 



Or, 



R — Spt. camphorse . . fgj (30.0). 

Spt. lavai 

Alcoholis 

S. — Apply locally 



Spt. lavandulse ) __ » z .. /cri n\ nr 

Alcoholis r aaf*y(60.0).-M. 



R. — Camphorse ) ._ . , . n , 

01. menth. piperit. } * ' * aa ® ( 4 - )- 

Chloroformi f£ss. (15.0). 

Alcoholis • • • q. s. adfgiij (90.0).-— M. 

S. — Shake the bottle and apply a little of the fluid to the head. 

Where headache depends upon fatigue, either general or local, 
stimulating treatment is necessary. If eye-strain be the cause, full 
doses of strychnine or nux vomica are of service, but these remedies 
cannot be used if there is much retinal irritability. In many instances 
a combination of caffeine, bromide of potassium, and antipyrin is very 
successful, as follows : 

R. — Caffeinse citratis gr. xl (2.65). 

Potassii bromidi giv (16.0). 

Antipyrini §ij (8.0).— M. 

Ft. in chart. No. xx. 
S. — One powder in water as needed. 

Sometimes the caffeine makes the headache more acute, and if this 
occurs only the antipyrin and bromide can be used. (See articles on 
Antipyrin, Acetanilid, and Phenacetin.) 

Another useful prescription is — 

R. — Extract, guaranse gr. x vel xx (0.65-1.3). 

Ext. apii graveol gr. x (0.65). — M. 

Ft. in capsul. vel chart, vel pil. No. x. 
S. — One every half hour till relieved or three are taken. 

Sleep is generally a more useful prescription than any drug, and 
if city life creates so much mental anxiety during the day as to be 
wearing upon the nervous system or make the patient wakeful at 
night, business must be put aside and health and recreation sought 
at a watering-place. Horseback exercise is very useful indeed, and 
should be resorted to by all who can afford it if they are sufferers 
from nervous headaches. 

A form of headache which is often very severe, sometimes fleeting, 
sometimes persistent, is that due to gout, and it is to be treated by 
means quite distinct from those named so far. Some practitioners of 
wide experience employ salicylic acid in doses of from 5 to 15 grains 



046 DISEASES. 

(0.3-1.0), while others rely on the iodide or acetate of potassium. 
In cases where anaemia is present Peabody uses the following pre- 
scription, which is compatible, whereas most of the preparations of 
iron and salicylic acid are incompatible : 



R . — Acid, salicylic 

Ferri pyrophosphate . . . 

Sodii phosphatis 

Aquae dest 

-This is to be taken every three hours 



gr. xx (1.3). 
gr. v (0.3). 
gr.j(0.05). 

fjss (16.0).— M. 



Cohen has used the following, which is more pleasant to the taste : 

R. — Sodii salicylatis £iv (16.0). 

Glycerini f^ij (60.0). 

01. gaultheria? TT\,xx (1.3). 

Tr. ferri chloridi f^iv (16.0). 

Acid, citrici gr. x (0.65). 

Liq. ammonii citratis, B. P. 1 . q. s. ad f§iv (120.0). — M. 
S. — Dessertspoonful (8.0) in water twice, thrice, or four times a day. 

Other cases of a gouty headache require colchicum, particularly 
if the gout be widely distributed in its manifestations, and to these 
Hamilton gives — 

R. — Vini colchici seminis f^ss (16.0). 

Potassii acetatis 1 

Potassii iodidi V aa f£v (20.0). 

Tr. cimicifugse racemosaej 

Aquae q. s. ad f^iv (120.0).— M. 

S. — Teaspoonful (4.0) every four hours. 



HEART DISEASE. 

(For Treatment of Angina Pectoris see p. 536.) 

The writer classifies all forms of heart disease under this heading 
advisedly. In valvular disease the profession is beginning to under- 
stand more and more that the mere destruction or laming of this valve 
or that has little to do with the treatment, although the ultimate 
result of the case is somewhat dependent upon these conditions. It 
matters not whether the leak in a valve be minute or great, provided 
the heart can still do its work ; the condition of the cardiac muscle 
is the important factor to be considered. If an irreparable leak 
exists in a pump which cannot be stopped for repairs, the question is 
not, Can we cure that leak ? but rather whether we can work the pump 
with enough force and rapidity to obtain all the water needed for the 
maintenance of life. Some physicians use heart tonics, such as digitalis, 
whenever they find a valve diseased, as if to mend the broken valve. 
Nothing can be more erroneous, for a valve once injured is never re- 
generated. 

1 Liquor ammonii citratis, B. P., is made by adding 5 fluidounees (imperial meas.) 
of strong solution of citrate of ammonium to 15 fluidounees (imperial meas.) of dis- 
tilled water The stronger solution of citrate of ammonium is made by taking 12 
ounces (avoirdupois) of citric acid, strong solution of ammonia 1! fluidounees, and 
adding enough distilled water to make 24 Huidounces (imperial meas.). 



HEART DISEASE. 647 

It should be an invariable rule with every physician in examining 
a patient with heart disease to determine whether or not the tissues 
of the body receive their normal blood-supply. If they do not, even 
though the leak is so small as almost to escape notice, treatment is to 
be instituted ; but, on the other hand, if the murmur heard on auscul- 
tation is as loud as that of a machine-shop and the tissues are not 
starved, no remedy is needed. Indeed, it not rarely occurs that no 
murmur can be heard in the presence of signs of circulatory feebleness, 
because the heart may be too feeble to drive the blood past the leak- 
ing valve with sufficient force to produce any sound. 

Another very important point in regard to the treatment of cardiac 
disease in children is the remembrance that the stunting of the body 
and the slowness of growth are not merely the result of heart trouble, 
whereby the tissues do not increase in size from lack of nourishment, 
but occur for a special purpose. Let us suppose that a child of eight 
or nine years has scarlet fever or rheumatism, which leaves the cardiac 
valves impaired in function for a few days, or hours at least, the 
question must arise in the heart: " Can I properly fill all the blood- 
vessels?" If the heart can supply the vessels, the child lives, but is 
stunted, because Nature is wise enough to understand that the strug- 
gling heart has all it can do to supply even a stunted frame, and 
realizes that a rapidly increasing area of blood-vessel surface in a grow- 
ing child would exhaust the cardiac muscle. 

The physician should not permit the parents to worry over this lack 
of growth, but by the use of gentle gymnastics or tonics, and attention 
to the care of the general health, he is enabled to improve the cardiac 
condition. As soon as this organ is strong enough to permit of growth, 
growth will take place. 

In the general treatment of heart disease in persons who have until 
recently had no signs of heart failure the most important thing for the 
physician to prescribe is rest. A tired heart cannot supply an active 
body. 

Having made these preliminary remarks, let us turn to the direct 
application of drugs to heart disease, the chief drug in the list being, 
of course, digitalis. 

The value of digitalis may be said to rest upon a number of 
influences possessed by it. In the first place, evidence is constantly 
accumulating to show that digitalis increases the nutrition of the- 
heart-muscle by the stimulating influence which it exerts on the 
pneumogastric nerve, this nerve having been partly proved to be a 
trophic nerve of the heart. Aside from any such nervous influence, 
the heart-muscle receives a greater blood-supply under the use of digi- 
talis, since both diastole and systole are influenced by the drug, the 
systole being more complete and the diastole being prolonged and 
more extensive- 
Two theories concerning the nutrition of the heart-muscle through 
its blood-supply have been promulgated. One is, that the coronary 
arteries are filled with arterial blood as the heart drives its contents out 
of the left ventricle into the aorta, or, in other words, during systole. 
The other hypothesis rests upon the belief that the contracting muscle 



648 DISEASES. 

prevents a free circulation of blood through the cardiac blood-vessels, 
and that the blood is driven into the coronary arteries during diastole 
by the pressure in the aorta, the aortic valves being closed. The 
latter view is incorrect so far as the coronary arteries are concerned, 
for thev are filled during ventricular systole, and this systolic con- 
traction of the muscular fibres urges onward the blood already in 
the intramural vessels. Nevertheless the complete passage of the 
blood through the smaller vessels of the cardiac muscle only takes 
place as relaxation or diastole occurs. The ground for this belief 
consists in the observation that a muscle when firmly contracted 
always presses upon its supplying blood-vessels, and particularly 
interferes with capillary flow. The heart of one of the lower animals, 
if carefully watched after the chest-w T all is removed, will always be 
found to become paler during systole and redder during diastole. As 
the blood everywhere in the body nourishes the tissues, not when in the 
arteries, but while passing through the capillaries, it would seem self- 
evident that, while the coronary arteries are filled by the systole or 
contraction of the heart, the nutritive changes and perfect capillary 
circulation go on during diastole. If these things are true, the increase 
in cardiac nutrition and growth under the action of digitalis is only 
what one would expect, for we have learned when studying this drug 
that it prolongs diastole and increases the force and volume of the 
systolic w T ave of blood. In other words, digitalis fills the coronary 
arteries almost to bursting, and so, when diastole occurs, not only 
floods the cardiac capillaries with blood, but prolongs the period during 
which the interchange between the blood-stream and tissues takes 
place. 1 

There is still another way in which digitalis does good in cardiac 
disease by reason of its peculiar powers. Normally, the heart beats 
fast or slow according to the demands for blood made upon it by the 
system, and its action is varied by the calls which it receives from the 
tissues. In heart disease, with failure of compensation owing to the 
leaky valves, the tissues are starved, and continually send messages 
for more nourishment to the cardiac muscle, which finally becomes 
exhausted by its endeavors to supply their wants, and beats now fast 
and now slow, uncertain what to do. If digitalis is given, the vagi 
render the cardiac action regular and effective, acting as regulators 
and directors of its energies, thereby supplying the tissues and using 
the remaining power of the heart to the greatest advantage, in addi- 
tion to improving its blood-supply by the methods already described. 
The starving tissues of the body having been satisfied, as Wood has 
eloquently expressed it, "the angry messengers from the periphery 
cease their callings, and the heart is at peace and in comfort." 

From what lias been said it becomes evident that this drug, digi- 
talis, generally docs good when the heart is weak, and we find for this 
reason thai cardiac dilatation, simple cardiac failure, or heart-failure 
dependent upon the presence of poisons, all indicate its use. 

The mechanism of the action of digitalis in the different cardiac 
valvular Lesions still remains to be described, and before doing so the 
1 Sec article on Digitalis in Part J I. of this book. 



HEART DISEASE. 649 

author desires to remind the reader that a patient under the full influ- 
ence of digitalis ought to maintain the recumbent posture. (See article 
on Digitalis.) Farther, the drug tends to accumulate, and therefore it 
should be stopped for several days at the end of each week of its use. 

Digitalis should be begun in small doses, which can be gradually 
increased in size if need be. 

Taking up the most common condition, that of mitral regurgitation, 
we find that in this disease the blood passes, in its normal flow, from 
the auricle into the ventricle, and, when the ventricle is filled, that 
the cardiac muscle contracts on all sides equally. Normally, the 
mitral valves close the auriculo-ventricular opening and prevent any 
of the blood from regurgitating back into the auricle, and the greater 
the pressure the tighter they become. Abnormally, the blood is still 
pressed upon on all sides as before, and, trying to escape, as do all 
liquids, from pressure, finds that, owing to disease of these valves, it 
can, in part at least, slip back into the auricle from which it came, 
rather than pass out into the high pressure of the arterial system. 
The ventricle, therefore, propels blood in two directions — in the wrong 
way and in the right way. If the leak is large enough to permit of the 
regurgitation of a large part of the blood, then death occurs. Digitalis 
does good in mitral regurgitation, because, by increasing the force of 
the ventricle, it increases the friction at both the mitral leak and the 
aortic opening ; but, as the aortic opening is a large one and the mitral 
leak a small one, the greater quantity of blood passes out into the cir- 
culation. The same fact arises for consideration as before — namely, 
that it is not the amount of leak, but the amount of supply to take its 
place, which is the vital question in the case. Sometimes relief does 
not occur, and the patient is made worse by digitalis, because the leak 
is increased as much as the normal flow. 

In mitral obstruction the difficulty is that the blood cannot enter 
the ventricle with sufficient rapidity, and this part of the heart con- 
tracts before it is well filled. By the prolongation of diastole the 
blood is given sufficient time to enter and the ventricle is filled, send- 
ing out into the system a large wave of blood when it contracts. 
Further than this, the stimulation of the right ventricle by the 
digitalis enables this part of the heart to overcome the tendency to 
congestion which arises from the obstruction on the left side of the 
heart. Often the right side of the heart must be relieved by vene- 
section and active purgation. 

In aortic stenosis there is obstruction to the normal flow of blood 
out of the heart, and the digitalis is needed to increase the ventric- 
ular force, so that it may overcome the difficulty. 

In aortic regurgitation digitalis, by its stimulation of the heart, 
may cause a sufficient output of force to clear itself of the regurgi- 
tant flow, but in many cases the drug fails, because the prolongation 
of diastole gives so much more time for the blood to flow backward 
into the dilating ventricle. The cardiac remedies to be used in such 
cases are strophantus, in the form of the tincture, dose 3 to 5 drops 
(0.15-0.3), adonidin, dose J to § grain (0.013-0.025), and sparteine 
J grain (0.025). These remedies may also be used in the other forms 



650 DISEASES. 

of cardiac disease where digitalis fails. It is important to remember, 
however, that some cases of aortic regurgitation do improve, at least 
temporarily, under digitalis. 

Murmurs associated with evidences of cardiac failure do not always 
indicate the presence of valvular disease, for dilatation of the mitral 
orifice may prevent the proper approximation of the valves. In such 
a case digitalis, by relieving the relaxation, may produce a cure of an 
apparent valvular defect. 

Physicians often meet with cases of severe cardiac disease in which 
there are present a laboring heart, distended jugulars, and cyanosis, 
indicating engorgement of the right ventricle. This is to be relieved 
by free venesection from the arm, and, after the engorgement is re- 
moved, by the use of digitalis. 

In many cases of cardiac disease there is associated with the heart 
lesion general debility and anaemia. These cases should be treated not 
only by the use of heart tonics, but also by iron, arsenic, simple bitters, 
and. if constipation is present, by mild purgatives. 

In cardiac dropsy digitalis and the other heart stimulants do good 
by raising blood-pressure and pulse-force, and in some instances by 
stimulating the kidneys to increased efforts at elimination. (See 
Dropsy.) In these cases, too, the patient will often be greatly bene- 
fitted if he receive every few days a dose of one of the hydragogue 
cathartics, which will relieve his dropsy and unload the portal circula- 
tion. 

On the other hand, if the heart is feeble and the arterial tension is 
high, we not only have to give nitroglycerin to relax the spasm, but it 
is best to employ a cardiac tonic which at the same time that it stimu- 
lates the heart will not raise arterial pressure, as, for example, stro- 
plianthus, in preference to digitalis, which stimulates the arterial system 
and increases the tension. As digitalis is prolonged in its effect and 
nitroglycerin is fleeting, we should give the digitalis every eight or 
twelve hours, and the nitroglycerin every three or four hours. 

In sudden cardiac failure from weakness or poisons the use of 
ether and ammonia is to be resorted to at once, and these are to be 
followed by alcohol and digitalis if necessary. The ammonia is a 
direct heart-stimulant, as are also the alcohol and ether. 

In cardiac palpitation dependent upon indigestion this condition 
must be relieved by appropriate digestive remedies; but in that form 
of palpitation due to over-exertion or heart-strain digitalis is useful. 
Iron is to be used if the irritability is due to anaemia. Tea, coffee, 
tobacco, and excessive venery are to be forbidden. Sometimes nux 
vomica docs good by stimulating the heart and nervous system, and 
belladonna seems of great value where arhythmia is present. In other 
cases of arhythmia the patient will be more benefited by the use of 
cactus grandiflorus and sparteine, and sometimes a prescription of aco- 
nite and digitalis, as suggested in the article on Aconite. Ringer rec- 
ommends tic use of veratrine ointment over the praecordium in many 

of* til' 

1" cases of cardiac dilatation and asthenia digitalis is often very 
useful : hut should the patient be advanced in vears and have a ten- 



HEART DISEASE. 651 

deney to arteriosclerosis we should, simultaneously with its use, give 
nitroglycerin to relieve any arterial spasm which will resist the action 
of the heart. 

Very often such patients will suffer from scanty secretion of urine 
and albuminuria, and will develop cyanotic induration of the kidney. 
This may be controlled and greatly relieved by the use of full doses 
of digitalis, say 5 drops of the tincture every four hours with 20 
grains of bitartrate or citrate of potassium every four hours. The 
addition of the alkaline diuretic very greatly aids in the diuretic 
effect of the digitalis in these cases. Sometimes diuresis can only be 
established after free purgation. In some cases it is best to substi- 
tute for the digitalis either strophanthus or caffeine. Both should be 
given freely, say 3 grains (0.18) of caffeine or 5 minims (0.35) of the 
tincture of strophanthus every four hours. (See Nephritis.) 

Cardiac hypertrophy is rarely seen without some other lesion ac- 
companying it, but it may occur from prolonged and excessive exer- 
cise or other cause. It is to be treated by perfect rest and avoidance 
of excessive exercise, and by the use of moderate amounts of food of 
a non-stimulating character. Wines and coffee should be forbidden, 
and small amounts of veratrine ointment or a belladonna plaster may 
be placed over the prsecordium if the action of the heart is very exces- 
sive. Both palpitation of the heart and cardiac hypertrophy are very 
favorably influenced in many cases by aconite or veratrum viride. 

Physicians who are in the habit of seeing young men professionally 
will constantly have their attention called to a condition of shortness of 
breath on exertion, palpitation, or violent pulsation of the heart, and 
in some instances the development of severe symptoms which, at first 
glance, may seem to be those of true angina pectoris. In many of these 
youths there will be a history of the excessive use of tobacco, or that 
they have left college, where they have been indulging in severe ath- 
letic exercise, such as running or bicycle-racing, and have gone into 
business, where they lead a most sedentary life, In these cases the 
condition which exists is comparable to the condition which exists in 
a steamer whose engines are too strong for her hull. The heart, which 
has heretofore been supplying the body of an athlete with blood, now 
finds itself too strong for the sedentary individual. There is prob- 
ably no remedy which will give such good results under these circum- 
stances as aconite, given in the dose of 1 minim (0.05) of the fluid extract 
or 2 to 3 minims (0.1-0.15) of the tincture three times a day, partic- 
ularly if at the same time a good belladonna plaster about four inches 
square is applied over the praecordium. Many cases of tobacco heart, 
in which there is arhythmia, with an excessive cardiac impulse over 
the prsecordium, with palpitation on exertion, will be benefited by 
aconite used in this way ; but where the heart seems much depressed, 
so that the apex-beat is feeble and the first and second sounds are not 
clearly heard, aconite will seldom, if ever, do good. 

In that form of functional cardiac disorder due to indigestion aco- 
nite is not capable of producing the results which are obtained in the 
cases which we have just mentioned. It may, however, be used as a 
remedy of value at the same time that the physician is directing his 



652 DISEASES. 

attention to the cause of the trouble — namely, the gastro-intestinal 
disorder, with the treatment of which this article has nothing to do. 
Here, again, a condition of cardiac feebleness contraindicates the 
employment of this drug. 

Passing to the employment of aconite in cases of true cardiac dis- 
ease, we find that a careful study of a certain number of cases will 
soon show the physician that this drug is capable of doing more good 
in some instances than is digitalis. 

The history of the following case illustrates this point : A man, 
aged nineteen, was brought to the hospital suffering from aortic 
obstruction, and as a result of this was attacked with dyspnoea on the 
slightest exertion, marked cardiac arhythmia, with palpitation, some 
giddiness, and a tendency to nose-bleed. He stated that in the early 
part of the year, and for several years preceding it, he had been a 
deck-hand on a coastwise vessel, where he performed hard manual 
labor, notwithstanding the condition of cardiac disease which was 
present, and of which he knew nothing. During this time he suf- 
fered from no symptoms indicating cardiac disorder. In other words, 
compensatory hypertrophy was complete. Because of the exposure 
incident to the work he was forced, under the advice of a physician, 
to earn his living on shore. He was unsuccessful in trying to obtain 
employment, and a prolonged period of muscular inactivity followed. 
As a consequence of this the cardiac hypertrophy, which had hitherto 
been compensatory, was now excessive, and he suffered from marked 
cardiac palpitation, with disordered circulation in the extremities, 
and from a considerable amount of cough. Very early in the study 
of the case it was recognized that these disorders were due to the 
excess of cardiac hypertrophy, and not to failure in compensation, 
and, as a consequence, that a cardiac depressant was indicated rather 
than a cardiac stimulant in the shape of digitalis. 

He was given from 1 to 2 minims (0.05-0.1) of the fluid extract of 
aconite three times a day, and during the continuance of this treatment 
was purposely confined to his bed. At the end of the week so much 
improvement had taken place in his condition that he was allowed to 
rise and go about the ward as he wished, and after four weeks, the 
medicine being continued during this period, he was so well that he 
was discharged from the hospital, with no other evidence of cardiac 
disorder than physical examination would show. 

When aconite is used, rest in bed is essential, in order that the 
heart may not be excited to great activity by exercise of the limbs, 
and also because the recumbent posture allows the physician to use 
larger doses of the drug. 

An exceedingly useful treatment of valvular disease with or with- 
out excessive cardiac hypertrophy is rest in bed without medication. 
The results in some cases are extraordinary. 

Fatty heart occurs in two forms — that in which true fatty degen- 
eration has taken place in the muscular fibre, and (hat in which there 
is a deposit of fat about tin; heart and between the fibres. Nothing of 
any importance can be done for the firs! state, except to relieve arterial 

-ion if it he too high by the use of nitroglycerine or by the iodides. 



HEART DISEASE. 653 

Strophantus with or without nux vomica may be useful to relieve 
symptoms of cardiac distress. Much can be done for the second form. 
In neither form is digitalis of much value. If given, it should be 
combined with nux vomica, or nux vomica may be given alone in 
full doses. The patient suffering from the second form of heart- 
trouble is nearly always obese, and should abstain from fats and rich 
foods, from all sweet wines or malt liquors, from sugars and milk, 
and, at the same time, take exercise. At first this treatment may 
cause dyspnoea, but by gradually increasing the severity of the exer- 
cise great feats can generally be effected in the end, with marked 
improvement in the cardiac action. (See Obesity.) 

Heart disease associated with failure of the muscle may not only 
be treated with drugs, but with other remedial measures, such as 
gentle, active exercise, passive exercise, and baths, the latter being 
given with care to avoid too great shock and for the purpose of 
improving the general circulation. 

Within the last few years a method has been brought forward by 
Schott, of Nauheim, Germany, which consists in treating patients 
with feeble hearts by means of movements and baths of water derived 
from the springs at Nauheim. The movements are so-called resist- 
ance-movements, the patient slowly flexing and straightening his 
limbs and neck against gentle resistance on the part of an attendant. 
By this means the circulation of blood and lymph in the tissues is 
aided without tiring the heart. These resistance-exercises do not, 
however, agree with all cases. In persons with very feeble hearts 
massage given gently is far better. The rule should be, never to give 
enough exercise or massage to cause acceleration of the respiration or 
marked increase in the action of the heart. Very feeble cases should 
have the massage first, the exercise next, and the baths last. 

Before considering the use of the Nauheim bath it is necessary for 
us to have a clear conception of what it is and the methods by which 
it does good. There are six springs at Nauheim, of which three are 
used for bathing and three for drinking purposes. The latter are not 
of great importance and do not form part of the "cure " in the strict 
sense of the word, although the water from the "Kur" and "Karls- 
brunnen" springs are sometimes sipped in the morning before break- 
fast for their laxative effect. 

The bathing waters are derived from three sources : No. 12, or 
Friedreich Wilhelras Quelle; No. 7, or Der Grosse Sprudel ; and a 
new one, called No. 14. The water of all these is very heavily charged 
with carbonic acid by nature. So great is the pressure that the 
water is forced upward from a vertical pipe nozzle as high as fifty 
feet. In the case of springs 7 and 12 the delivery pipe permits the 
water to shoot upward, and it then falls back into adjacent tanks, so 
that during its rise and fall a large amount of gas is lost> and much 
of the lime and iron held in solution is precipitated in the tanks. This 
water is led to bath-tubs, and if the patient is feeble and the "cure" 
is just beginning, it is often diluted with plain water and sometimes 
heated. This forms the Thermal Sool-bad. 

Other baths are supplied by direct pipes, which carry the water 



(354 DISEASES. 

from the earth without the gas being allowed to escape in any quantity. 
This water sparkles as does soda-water, and is called the Sprudel- 
bad. Still another bath is provided in wilich there is an outflow- 
opening as well as an inflow-opening, and the patient sits in a tub 
into which freshly charged water is rushing as fast as it runs out. 
This is called the Strom-bad. These baths are all therapeutically 
powerful, but naturally, the first is not as active as the last. 

The therapeutic value of these baths depends upon their ability to 
cause dilatation of the peripheral capillaries, which thereby relieves 
internal congestions and enables the heart to pump blood more easily 
through the capillaries. They also stimulate the heart by reflex 
nervous action. When a patient is suffering from grave cardiac 
failure depending upon valvular disease, with grayness of the face and 
cyanosis of the lips, the baths should be begun very cautiously, using 
the Thermal Sool-bad. Even then, for the first minute after the 
patient enters the bath, he mav seem more oppressed than before. 
But in the next few minutes his apprehension passes away, and a 
feeling of warmth and comfort develops, so that after ten or fifteen 
minutes it will be found that his skin is uniformly reddened wherever 
it has been in contact with the gas and water. The time which the 
patient spends in the bath should be prescribed by a local physician. 

After the bath the patient is carefully dried by an attendant, 
and must rest absolutely in a reclining position for at least one 
hour. At first the bath is used only every two or three days. As the 
patient gets a little strength the baths are gradually increased in length 
and frequency, and finally additional mother salt obtained by the evapo- 
ration of the w T ater is added to the natural water in the tub. Later 
on, when still stronger, the patient takes the foam, or "strom" bath, 
in which the gas is present in such quantities that the water foams. 
This is, of course, very stimulating and dangerous for a weak patient 
with poor reaction. When the patient recovers enough to use gentle 
walking-exercise this is permitted, the resistance-exercise being 
employed on days between the baths as a rule. 

These baths may be prepared artificially and are resorted to in this 
country, being now installed in several watering-places. The form- 
ulae for making the baths are as follows in each 40 gallons of water at 
95 V.: 

Bath No. 1: sodium chloride, 4 pounds; calcium chloride, 6 

ounces. 

Hath No. 2: sodium chloride, 5 pounds; calcium chloride, 8 

OUll' 

Bath No. 3: sodium chloride, 6 pounds: calcium chloride, 10 
ounce-. 

Bath No. 4: sodium chloride. T pounds; calcium chloride, 10 
ounce-: -odium bicarbonate, \ pound: IIC1 (25 per cent.), 12 
ounces. 

Bath No. 5: sodium chloride, 9 pounds; calcium chloride, 11 

ounces: -odium bicarbonate, 1 pound; 11(1. 1 ', pounds. 

Bath No. <> : sodium chloride, 11 pounds; calcium chloride, 12 
ounce-: Bodium bicarbonate, 2 pounds; HC1, ; > pounds. 



HEMORRHAGE. 655 

The alkali should always be slightly in excess unless a porcelain 
or paper tub is used. 

A small bottle containing the hydrochloric acid is submerged at 
the bottom of the tub, uncorked, and its contents allowed to escape 
into the water, in which effervescence at once occurs, the patient 
entering the bath at that time. Recently Tyson has used a series of 
perforated iron tubes placed upon the bottom of the tub under a 
wooden rack. These tubes are connected to a large cylinder con- 
taining carbonic acid gas, which is allowed to bubble through the 
water, thus supplanting the crude method of producing the gas by 
the acid just named. The tub should be of wood. 

The numbers of the baths are simply numbers for different 
strengths. Patients may never use them stronger than that repre- 
sented by the second or third formula. Toward the close of the 
treatment the temperature may be lowered to 85° F. 

These baths are indicated chiefly for feeble hearts, as already 
stated. Thus, if there be cardiac dilatation resulting from such 
depressing causes as epidemic influenza, they often prove useful. 
So, too, in cardiac neuroses and functional disorders dependent upon 
lack of vasomotor tone they are serviceable. In valvular disease 
with perfect compensation they are not needed, and when compensation 
is ruptured they are dangerous, owing to the production of syncope. 
If the bath acts favorably, the pulse becomes stronger and fuller, the 
heart's action slower, and the physical signs of cardiac dilatation dis- 
appear. Congestive engorgement of the liver also passes away. As 
with all other methods of treatment, the cases submitted to this 
treatment should be carefully selected, as it has its therapeutic limi- 
tations. This treatment does not necessarily exclude the use of 
drugs. A liberal vegetable diet, with small amounts of meats, is 
given. 

HEMORRHAGE. 

{Including Menorrhagia, Metrorrhagia, Hcemoptysis, Hamiatemesis, 
Intestinal Hemorrhage, Hcematuria, and Post-partum Hemorrhaged) 

Under this heading the author will consider all forms of hemor- 
rhage which can be controlled by drugs or measures not directly sur- 
gical in their scope, with the exception of epistaxis, which has already 
been spoken of. 

Whenever a hemorrhage can be arrested by the application of a 
ligature or by compression, as in a cut of the finger or some similar 
wound, no styptic should be used. Styptics are employed for the 
double purpose of constringing the tissues and coagulating the blood, 
and, in consequence, form coagula which tend to make a nasty septic 
mass about the wound. In their place the physician should resort to 
a compress soaked in some antiseptic liquid or filled with some disin- 
fectant powder, and if this fails to control the bleeding, then ligation 
of the bleeding vessel becomes necessary. 

Where the bleeding point cannot be reached by direct compression 
or for ligation, the use of packing and of astringents is advisable, 



656 DISEASES. 

and drugs which are antihemorrhagic should be used by the mouth. 
As these forms of hemorrhage are generally given separate names, 
they will be separately considered. 

In all forms of hemorrhage in which the flow has been sufficiently 
great to endanger the patient's life resort should be had to hypoder- 
moclvsis or to transfusion. (See Hypodermoclysis and Transfusion, 
Part' III.) 

Recently gelatin has been employed externally to control hemor- 
rhage, and has been given hypodermically to aid in the coagulation 
of blood in bleeding parts which cannot be reached directly. Lance- 
reaux and Paulesco use the following formula : 

R — Gelatin., 

Sodii chloridi da gr. cl. (10.0). 

Aqua? destill.it O ij (1000 cc.). 

This mixture is sterilized by heat and 2 ounces (60 cc.) are injected 
into the tissues of the thigh or buttock. This is increased to 5 ounces 
(150.0) in later injections if they are needed. Usually one or two doses 
are sufficient. A like solution may be used locally to check oozing. 

Menorrhagia is an excessive flow of menstrual blood, either exces- 
sive in quantity during two or three days or prolonging itself over 
an unusual number of days, while ?netrorrhagia is a state in which 
bleeding takes place from the uterus independent of menstruation 
and at any period of the month, or even after the menopause has 
occurred. 

Menorrhagia, or excessive menstruation, is not to be judged by the 
amount of the flow, but by whether the loss is sufficient to cause 
decrease of health or to indicate disease. In some cases it is a means 
of relieving plethora. 

When the physician decides that something should be done to 
improve the condition of the patient, when suffering either from 
monorrhagia or metrorrhagia, it will be necessary for him to find 
out whether a polypus or other form of uterine disease is directly 
responsible for the trouble, and in the mean time to employ drugs 
known to act favorably upon uterine hemorrhage. The most 
prominent of these drugs are ergot and oil of erigeron, the first 
being the more active and the best remedy for active bleeding, the 
second better for oozing and for cases where there is a continual 



ik show. 



The fluid extract of ergot may be given in varying dose, from 10 
to 00 minims (0.65-4.0), according to the necessities of the case, and 
the nil of erigeron in capsules in the dose of from 3 to 5 minims 
(0.15-0.3), or, if* capsules cannot be had, the physician must employ 
the oil in ;iii emulsion made by using syrup of acacia or other similar 
Bubstance. Locally, cotton wet with a sterile solution of adrenalin 
(1 : 5000) chloride may be employed. 

Where menstruation is irregular and the monorrhagia is almost a 
metrorrhagia, bromide of potassium or sodium in the dose of 10 
grains (O.o5) several limes a, day is often very serviceable indeed, and 
the distilled extinct of hamamelis in the dose of 1 drachm (4.0) 
three times a day is almost as useful. Cannabis indica, if an active 



HEMORRHAGE. 657 

sample is obtainable, is also said to be of service, but the writer has 
never used it to any extent. Oil of cinnamon in the dose of J drachm 
(2.0) is very efficacious in the slow oozing of some cases where erige- 
ron cannot be used or obtained. Sometimes, where congestion of 
the pelvic viscera is the cause of the trouble, dry cups over the sacrum 
give relief. 

Hcemoptysis, or hemorrhage from the lung, is nearly always due to 
tubercular ulceration of a small or large blood-vessel, and the life of 
the patient depends in reality more upon the rapidity with which a 
clot naturally forms than upon the skill of the physician. Though 
text-books order atomized solutions to be inhaled and other remedies 
to be taken by way of the lung, in most cases these measures will be 
found impracticable, simply because the nervousness of the patient 
and the constant cough will not permit of inhalations to any extent, 
and even if a full breath is taken, it generally increases the bleeding 
and coughing. The only occasions on which inhalations of styptics 
are of service are those in which the hemorrhage is just beginning or 
so slight as to streak the sputum or to be at least thoroughly mixed 
with it. The solutions to be so employed must be used in an atomizer 
which will throw a fine spray — sufficiently fine to enter the smallest 
air-tubes with the inspiratory wave of air. A very good fluid is one 
made from Monsel's solution, as follows : 

R. — Liquor, ferri subsulphat gtt. xx to xxx (2.0). 

Aqua? dest f^iv (120.0).— M. 

S. — Use in an atomizer every few minutes. 

Or the following : l 

R. — Acid, tannic gr. xx (1.3). 

Glycerini fgij (8.0). 

Aquse dest q. s. adf^iij (90.0). — M. 

S. — Use in an atomizer. 

Or, 

R — Aluminis gr. vj (0.4). 

Aqua; dest •. . . f^iij (90.0).— M. 

S. — Use in an atomizer. 

Some clinicians advise that the patient should swallow, whether 
the hemorrhage be acute or not, not less than 1 to 1J drachms (4.0- 
6.0) of the fluid extract of ergot, or a solution made by adding 20 
grains of gallic acid to 1 ounce (1.3 : 30.0) of water; but it is difficult 
to understand how they can be of service. Tannic acid given by 
the stomach is not as good as gallic acid, because it must be absorbed 
and changed into gallic acid before it can reach the bleeding 
point through the circulation. On the other hand, the tannic acid, if 
locally used, is the better, for it constringes the tissues and forms a 
clot, whereas gallic acid does not coagulate the blood. There is no 
doubt that of all the internal remedies for hemorrhage from the lungs, 
aconite is the best. Careful studies show that ergot causes primarily 

1 If the Monsel solution does not stop the hemorrhage, tannic acid will probably 
fail ; but, more important, the two should not be used together, as they are incom- 
patible and the tannate of iron will be formed, which is as black as ink. 

42 



658 DISEASES. 

an increased flow of blood to the lung, although its dominant and final 
action is to cause contraction of the blood-vessels. Hemorrhage from 
the lung is to be regarded as any other hemorrhage. The object of 
the physician is not to stimulate the heart and vasomotor system, 
thereby increasing the leakage from the bleeding vessel, but to lower 
the arterial pressure to as low a point as is safe. The rule to follow 
is best stated as follows : If the patient is seen early in the attack, give 
full doses of aconite to prevent further hemorrhage. If when seen 
«o late that he is too much exsanguinated to use sedatives, place his 
head lower than the feet and apply Esmarch bandages to the limbs to 
keep the blood in the vital parts as far as possible. The use of stimu- 
lants can only increase the hemorrhage by increasing the pumping power 
of the heart and by dislodging the clot from the eroded blood-vessel. 

Daremburg and Yeo have employed ice or ice-cold compresses to 
the scrotum or vulva in such cases, and claim good results from this 
use of cold. 

To allay nervous excitement many writers advise that a hypodermic 
injection of morphine should be used. The author is convinced that 
it should be used, but with caution, for morphine is a circulatory 
stimulant, and by increasing the power of the heart increases the 
hemorrhage. Chloral and the bromides are often better remedies, 
and should be given by the mouth, or, if vomiting is present, they 
should be given by the rectum, dissolved in starch-water. (See 
Chloral and Bromides.) 

Sometimes the patient can point directly to the spot where he 
thinks the hemorrhage exists, and under these circumstance.) a dry 
cup or a piece of ice placed over this point may prove useful by 
causing a reflex contraction of the deeper blood-vessels. 

After an attack of hemoptysis there is great danger in many cases 
of a traumatic pneumonia being set up by the presence of the extrav- 
asated blood. This should be combated by the use of a carefully 
regulated diet, and the reduction of any arterial excitement by small 
doses of aconite in persons not weakened by advanced disease or bleed- 
in;/. Complete rest in bed is to be insisted on, and no stimulants 
allowed in food or drink unless the weakness of the patient requires 
them. 

Hcematemesis. — This depends either upon some injury to the stom- 
ach or, much more commonly, upon gastric ulcer, cancer, or some other 
severe form of gastric trouble, and is one of the easier of the so-called 
4> internal hemorrhages " to treat, because by ordering the patient to 
swallow styptic drugs we can act directly upon the bleeding surface. 1 
Adrenalin may be given, and ice should be swallowed frequently, 
Or : » minims (0.15) of MonsePs solution may be used in a half 
tumblerful of water every fifteen minutes till four doses are taken. 
Tannic acid may be given instead in the dose of 20 grains to a 
drachm (1.3-4.0), but the two should never be given at once in 

1 EIsematemesiG also ensues as :i result of swallowing blood which lias escaped into 
the mouth or naso-pharynx, and this symptom is sometimes induced by malingerers 
in order t<» further their ends. These forms of heematemesis should, of course, he sep- 
arated from those dependent upon some lesion in the stomach itself. 



HEMORRHAGE. 659 

the same case. (See foot-note to p. 657.) Monsel's salt may be given 
in pill in the dose of 2 to 3 grains (0.1-0.15). The acetate of lead 
is also of value in pill form in the dose of 2 to 3 grains (0.1-0.15) 
with morphine or opium. Tincture of the chloride of iron, the sul- 
phate of iron, turpentine, ipecac, ergot, and hamamelis may all be 
used, the last three particularly in slow or passive hemorrhages. 
Sometimes nitrate of silver in the dose of J of a grain (0.016) in, 
pill form is of service if the hemorrhage is a slow one. 

Hemorrhage from the bowel is to be treated according to its point 
of origin. If in the small intestine, as from ulceration of Peyer's 
patches or other glands, the medicines must be used by the mouth ; if 
it be from the colon or rectum or from hemorrhoids, medication must 
be by way of the anus. 

Hemorrhage of the first class is best combated by the applica- 
tion of a small ice-bag to the belly and by the use of Monsel's salt 
(ferri subsulphas) : 3 grains (0.15) made into a pill should be given 
every half hour or oftener, the pill being made hard enough to reach 
the intestine without being dissolved and its contents decomposed in 
the stomach. Ergot has been resorted to, but is of doubtful value 
even if used hypodermically (see Ergot) ; but tannic acid may be given 
with advantage in large amount in solution if the Monsel salt is not 
obtainable. The other remedies which are of service are sulphuric 
acid in the dose of 5 to 10 minims (0.3-0.65) in water in acute or 
passive bleeding, or turpentine given in capsule, or, better still, in 
emulsion with acacia in the dose of 10 minims (0.65) every half-hour, 
particularly when the hemorrhage is not active. Chloride of calcium 
is useful (which see). Acetate of lead and camphor in the following 
pill may be of service in some cases : 

R. — Plumbi acetatis gr. v (0.3). 

Camphorse gr. x (0.65). — M. 

Ft. in pit. No. v. 
S. — One pill every hour. 

Where the hemorrhage is dependent upon ulceration of the colon 
or rectum injections are to be resorted to. These are both styptic and 
curative, the styptic injections being particularly useful when the 
bleeding is to be stopped at once, the others where it is sought to 
remove the condition producing the trouble. 

To the first class belong alum, sulphate of copper, Monsel's solu- 
tion, sulphate of iron, tannic acid, and cold water. In the second we 
find nitrate of silver, the sulphates of copper and of iron, and the 
chlorate of potassium. 

The alum solution used should be fairly strong, 10 grains to the 
ounce (0.65:30.0); the copper, 5 grains to the ounce (0.3:30.0); 
the Monsel salt, 10 grains to the ounce (0.65: 30.0); or -J- to 1 
drachm of Monsel's solution to each 2 ounces (60.0) of water. The 
tannic acid should be used in the strength of 20 grains to the 
ounce (1.3:30.0) of water and glycerin. When chlorate of potas- 
sium is used, it should be employed in saturated solution in small 
injections (25 grains to the ounce [1.65:30.0]), or in weaker so- 



600 DISEASES. 

lution if the injection be a large one (10 grains to the ounce 
[0.65: 30.0]). 

These injections should be carefully given, and the success or 
failure attending the treatment of these states depends as much upon 
the technique of the operation as upon the injection of the medicinal 
substance. It should never be forgotten that an injection designed 
for local medication should be as small in bulk as circumstances will 
permit. Thus, in inflammation of the rectum the amount of the 
injected liquid should not be above 4 ounces (120.0) at the utmost, 
and preferably 2 ounces (60.0) unless the diseased area is high up. 
An enema is given in bulk so as to cause distention and excite the 
bowel to movement, whereas from a medicinal injection no movement 
is desired. Again, the apparatus for sending in the fluid ought not 
to be a "family" or ordinary syringe, but a fountain syringe, the 
pressure being hydrostatic. This may be dispensed with if the injec- 
tion be small and only intended for the lower part of the rectum, but 
it is indispensable if the injection be intended to reach the upper part 
of the colon. The entrance of the liquid should always be gradual 
and easy. If resistance is met with, the pressure must be overcome, 
not by force, but by waiting a moment until it passes off. When the 
entire colon is to be flooded, at least a gallon of warm liquid may be 
needed. In these cases those drugs which are capable of absorption 
and the production of poisonous symptoms are not to be used except 
in small amounts. (See Enteroclysis. Part III.) 

Where the injection is to reach high up into the bowel the patient 
should be put in the lithotomy position with the buttocks elevated. 

Sometimes in dysentery the injection of a pint to a quart of ice- 
cold water has a most favorable effect upon bloody purging. 

Whenever a medicated injection is to be used for the cure of ulcers 
w T hich cause hemorrhage, the entire tract which is to be invaded 
should be washed out with pure water or with a saline or soapy liquid, 
in order to dislodge mucus and faeces, which prevent the drugs from 
acting on the bowel-wall. 

Hematuria is a condition in which blood appears in the urine, and 
may be divided into two classes — that in which the blood comes from 
the kidney or bladder, and that in which it comes from the urethra. 
In the first class the blood is always well mixed with the urine, 
which is changed in color from its decomposition, and appears either 
through the entire act of urination or just at the end of the act. In 
those instances in which the blood is in the first part of the stream 
it arises in the urethra, is nearly pure, and not well mixed with the 
urine 

If the blood is due to the presence of an acute nephritis, the 
kidneys need treatment, and for directions as to this point the article 
on Acute Nephritis should be read; while, if the hemorrhage is due 
to the presence of a lesion in the bladder, the directions governing 
fche use of turpentine, erigeron, or ergot, as given for Menorrha- 
gia and Metrorrhagia, should be followed, or if any morbid growth 
Be present it should be removed. Sometimes 5 to 10 grains (0.35- 



HEMORRHAGE. 661 

0.65) of camphor in divided doses are of service, given in pill form, 
while in others cannabis indica is of value. 

Gallic acid, in 20-grain (1.3) doses, may be used, and is very val- 
uable. If the hemorrhage is alarming, injections of astringent 
washes, such as 2 or 3 grains of alum to the ounce of water, should 
be injected into the bladder. It must be remembered, however, that 
this simply fills the bladder with clots, which are not readily passed 
and are liable to become septic. 

A very useful prescription is — 

R.— Acid, gallic 3J (40). 

Acid, sulphuric, dil f.^ij (8.0). 

Aquae q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0j in ^Yater every four hours. 

Malarial infection is sometimes accompanied by hematuria or hemo- 
globinuria. The cause is very obscure, and an immense amount of 
discussion has taken place as to its proper treatment. Many physicians 
assert that the use of quinine in these cases produces disastrous results, 
others claim that the drug is most valuable. The value of quinine con- 
sists, undoubtedly, in its ability to prevent other attacks, rather than to 
relieve that already present or its result — the hematuria. If an exam- 
ination of the blood shows the presence of the gestivo-autumnal para- 
site, quinine is to be freely used ; but if not, it is to be avoided. 
Personally we believe that malarial hematuria and hemoglobinuria 
will ultimately be found to depend upon very different causes. In 
some cases it will be found that the true malarial parasite is the 
cause of the disease. In other instances it will probably be discovered 
that an entirely different organism belonging to the same general type 
of parasites is responsible for the development of* this dangerous and 
much to be dreaded complication. (See Cinchona, Part II.) Hypo- 
sulphite of sodium is a most useful remedy in malarial hematuria in 
the dose of 5 to 15 grains (0.3-1.0) every five hours. Many prac- 
titioners use as much as a drachm of hyposulphite of sodium every 
two hours till purgation takes place, give morphine and atropine 
hypodermically to relieve pain and quiet the stomach, apply cups 
over the kidneys, and give water to drink so as freely to flush the 
kidneys. 

Postpartum hemorrhage is to be controlled by the use of abdominal 
friction and kneading or grasping the dilated uterus through the re- 
laxed abdominal wall ; by the use of drachm doses of the fluid extract 
of ergot or a wineglassful of the wine of ergot ; and by the irritation of 
the uterine wall by passing the hand, which must be absolutely aseptic, 
up through the vagina into the uterine cavity. In other cases injec- 
tions of sterile water as hot as can be borne may be resorted to. 

In all forms of local hemorrhage from small vessels adrenalin 
chloride is to be thought of both as a local application or as a remedy 
suited for internal use. (See Suprarenal Gland, Part II.) 



(362 DISEASES. 



HEMORRHOIDS. 

Hemorrhoids are vascular dilatations of capillaries, arteries, or ven- 
ules situated outside or inside of the sphincter am, or are composed, 
in the case of what are called external piles, of tags of skin which 
are more or less vascular and become troublesome when inflamed. 

The internal pile, if large, is apt to prolapse and to become 
strangulated by the sphincter muscle. It is covered by mucous 
membrane, and is sometimes very small or like a mulberry in shape, 
consisting of a tuft of capillaries, a loop of an arteriole, or of a venule. 
The capillary or arterial hemorrhoid is apt to be bright red, and to bleed 
profusely when touched or when scraped by hard faeces. The venous 
tuft also bleeds, but not so freely, and the blood is not so bright in 
color. In cases in which the hemorrhoids "come down" — that is, 
pass out through the anus, so being in danger of becoming stran- 
gulated — the protruding mass should be washed with cold water, 
thereby at once cleansing the mass and reducing its congestion, 
and then gently pushed back with the fingers, which should be well 
oiled. Care should be taken that an external hemorrhoid is not 
mistaken for an internal pile, since if an external growth is pushed 
through the sphincter, it also becomes strangulated. 

The treatment of internal hemorrhoids is to a great extent iden- 
tical with that of the external variety. A suppository may be used, 
made up as follows, if there is a tendency to slight hemorrhage : 

R. — Acid, gallic gr. xx (1.3). 

Extract, opii gr. j (0.05). 

Extract, belladonnse gr. ij (0.1). 

01. theobromse q. s. — M. 

Ft. in suppos. "No. x. 
S. — Use one every night. In place of tliis, distilled witch-hazel extract may be 
injected into the rectum" to the quantity of 1 or 2 ounces (30.0-60.0). 

If the hemorrhage is profuse, the physician should use a speculum, 
find the bleeding point, and touch it with strong nitric acid, followed by 
the suppository named above. If this is done, the bowels should be 
confined for some days, until the spot under the slough made by the 
acid can heal. If the prolapsed hemorrhoid is inflamed and difficult 
of reduction, the following ointment of Mathews may be ordered : 

R. — Cocain gr. xij (0.8). 

Iodoformi , 3j (4.0). 

Extract, opii gr. xxx (2.0). 

Petrolati 5j (30.0).— M. 

S.— r>e a- ;i salve. 

[f the pile still refuses to be reduced, place the patient in bed and 
apply hot compresses, and if this fails, operation is demanded. 

The treatment of external piles themselves consists in the mainte- 
nance <>f* the most rigid cleanliness. Immediately after each move- 
ment the parts should be thoroughly washed by means of a sponge 
dipped in cold water, or, better still, by the use of the bidet or a nozzle 
attached to a Fountain syringe or to the general water-supply. (Sec 
Cold, Pari III.) A Iter they are thoroughly cleansed, it is well to 



HEPATITIS. 663 

bathe them with distilled extract of hamamelis. Often it is well to 
precede the regular morning evacuation by a cold rectal injection of 
pure water to soften the faeces, and, more important still, to decrease 
congestion. If the inflammation of the external piles is very acute 
and profound, the patient should be placed in bed and the cold injec- 
tions frequently repeated or hot compresses applied to the anus. After 
the acute stage is passed a lotion of lead-water and laudanum (lauda- 
num fass (15.0) to dilute lead-water f^ij (60.0) may be used. 

The injection of carbolic acid into hemorrhoids is a dangerous 
practice, and, if employed, only 1 drop is to be used. 

In addition to these applications there are important general rules 
to be observed. 

The patient's habits should be so arranged that his daily act of 
defecation is at night before going to bed, rather than in the morn- 
ing, as under these circumstances the rest in bed relieves congestion 
and soreness, which the maintenance of the erect posture might make 
worse. Plethoric persons should not use upholstered chairs for office 
or lounging purposes, as the heat of the body relaxes the rectal tis- 
sues. A cane-seated chair is best, or an air-cushion with a hollow 
centre. The liver plays a most important part in relation to hemor- 
rhoids, and, if it is congested, congestion of the hemorrhoidal veins 
is very apt to ensue. The connection between the liver and the 
hemorrhoidal plexus is most intimate, since this plexus is formed by 
the superior hemorrhoidal veins, which are branches of the inferior 
mesenteric, and the middle and inferior hemorrhoidal veins, which 
terminate in the internal iliac. The portal venous system is com- 
posed in part of the inferior mesenteric vein, and any obstruction to 
venous flow in the liver at once results in engorgement of the 
hemorrhoidal plexus. 

(For the surgical treatment of piles reference must be made to 
surgical works.) 



HEPATITIS. 

(Acute and Chronic Hepatitis and Hepatic Abscess.) 

Inflammation of the liver may be produced by many causes, such 
as injuries, cold, exposure to high heat (as in the tropics), syphilis, 
and the presence of any infectious disease or of parasites. It may 
also arise from alcoholism. The acute form is rarely directly pro- 
duced by syphilis although it may arise indirectly from this disease, 
being due to the absorption of septic materials into the circulation 
from wounds or sores. The hepatitis of hot] climates is generally sub- 
acute or chronic. The pain, swelling, and general symptoms of the 
acute form of inflammation of the liver are described thoroughly in the 
text-books on the practice of medicine. The measures commonly 
adopted for the relief of the symptoms and the disease itself are of two 
kinds : the first, medicinal ; the second, dietetic. 

The patient, if the attack be acute or severe, will commonly be 



664 DISEASES. 

found in bed. owing to the pain and fever, but if not he must be 
placed in bed and kept in a recumbent posture. Over the surface 
of the right hypochondriurn should be placed two cantharidal blisters 
of the diameter of from one to three inches, or, if this is not possi- 
ble, a large mustard plaster is to be used. Sometimes hot cloths 
applied over this area not only give relief, but also aid in the forma- 
tion of the blister. At the same time, if the bowels are greatly con- 
fined, a saline purgative, magnesium sulphate, should be given, and 
it is often wise to precede it several hours by small doses of calomel 
given in fractional doses. In regard to internal medication, the phy- 
sician should recollect that hepatitis is, like every inflammation, a local 
hyperemia or vascular engorgement, and, in consequence, that aconite 
in full doses is useful. Veratrum viride may be used, but as it may 
produce vomiting and disturb the liver, it should rarely be employed. 
The kidneys may be kept active by spirit of nitrous ether and citrate 
of potassium, or by any one of the diuretic waters, such as Vichy, in 
moderate quantities. 

If the inflammation is not aborted by this treatment, it may go on 
to hepatic abscess. 1 If hepatic abscess develops, the best thing to be 
done is to aspirate and draw off the pus. Very frequently the in- 
flamed organ will form so strong an attachment with the peritoneal 
coat of the abdominal cavity that a bistoury may be used to free the 
pus if an aspirator is not at hand. After pus is once formed any con- 
stitutional evidence of its presence, as by night-sweats, hectic, or 
rigors, is a sign for immediate interference with the purulent collec- 
tion by the physician. If amoebic dysentery exists, it must be cured 
as rapidly as possible by the measures generally employed for this 
purpose. (See Dysentery.) 

The diet during the early and later stages of acute hepatitis should 
be limited to those articles of food which are easily digested and assim- 
ilated, and rich or greasy dishes are to be excluded. " Strong foods," 
as meats of all kinds, particularly beef, pork, and mutton, are to be 
sedulously avoided. All spices in the food must be forbidden, and 
alcohol utterly tabooed. If koumyss cannot be had, the patient may 
be fed on peptonized milk or pancreatized oysters. (See Part III.) 
After the abscess develops the same recommendations are to be fol- 
lowed, and the diet is to be as supportive as possible, small doses of 
quinine and iron being used. 

I ji the treatment of the subacute or chronic hepatitis of hot 
climates no remedy compares to freshly prepared strong nitromuriatic 
acid, used both externally and internally. The acid should be a deep 
lemon color, and be mixed with water only when about to be taken, 
in the 'lose of 3 to 4 minims (0.15-0.2) three times a day. This rem- 
edy is contraindicated in acute hepatitis, because it acts by stimulating 
the organ, and would only increase the severity of the acute form of the 
disease if administered at this time. Externally, it is to be used by 
mixing it with water and applying it by means of a flannel wrung out in 

1 Just here ii may be well to recall that many cases of hepatic abscess are now 
known to be due to dysentery, and that the diseased state of the lower bowel may 
result in infection of the liver. 



HICCOUGH. 665 

the mixture, or by placing it on spongiopiline in the proportion of from 
1 to 3 fluidrachms to the pint (4.0-12.0 : 500 cc.) of warm water and 
applying it over the liver. If 3 fluidrachms (12.0) irritate the skin 
too greatly, the smaller quantity should be employed. This applica- 
tion causes a tingling of the skin and a localized sweat. 

The hepatitis due to syphilis generally shows itself as a cirrhosis, 
and is to be treated by antisyphilitic measures. (See Syphilis.) 

If ascites develops from cirrhosis, the liquid is to be withdrawn, 
and frequent aspirations, as often as the liquid returns, have been 
known to result in apparent cure or arrest of the disease. In all forms 
of chronic hepatitis iodide of potassium is a useful remedy in the dose 
of from 5 to 10 grains (0.3-0.65) three times a day, and larger amounts 
should be used if the disease be due to syphilis. 



HICCOUGH. 

This is an affection arising from many causes, depending upon irri- 
tability of the nerves supplying the diaphragm as a result of gastric 
irritation, nervousness, uraemia, and as a complication of several 
exhausting diseases, such, for example, as typhoid fever. 

The mechanism of its production rests upon the sudden contrac- 
tion or descent of the diaphragm, whereby a vacuum is formed in the 
chest into which the outside air attempts to rush, but is prevented 
from doing so by a sudden closure of the glottis, the peculiar sound 
of the hiccough being thus developed. Generally the symptom stops 
of itself, but it may become continuous and excessive. 

The remedies to be employed are used according to the cause of 
the disorder. If there be gastric or intestinal irritation, the irritating 
matter must be removed by emetics or purges, and nervous and local 
sedatives used. A few minims of spirit of chloroform do good in many 
cases, and a little tincture of capsicum may be employed in other 
instances, say 2 or 3 minims (0.1-0.15) well diluted. Children should 
have only \ to 1 minim (0.025-0.05) of the tincture, well diluted. 
Spirit of camphor, or the tincture of valerian, in the dose of 1 drachm 
(4.0), may be serviceable, and Hoffmann's anodyne is peculiarly 
efficacious in the dose of 1 drachm (4.0) in ice-water. In the hiccough 
of typhoid fever nothing compares to musk, 10 grains (0.65) by the 
rectum, and, if this cannot be used, oil of amber may be given by 
the mouth in the dose of 5 to 10 minims (0.3-0.65) in capsule or emul- 
sion, and followed by a drink of milk to prevent irritation of the 
stomach. Nitrite of amyl may also be inhaled. When hiccough is so 
persistent as to endanger life it must be controlled by the use of 
bromide of sodium and deodorized laudanum given by the bowel. 
(See article on Vomiting, for directions.) 

Where external remedies are resorted to, ether thrown in a fine 
spray on the epigastrium may stop an attack. 

In cases where the affection comes on after meals and is due to 
indigestion, a course of tonic treatment will often give relief. Thus 



$SQ DISEASES. 

mix vomica in pill or tincture, accompanied by some dilute mineral 
acid, such as hydrochloric or nitric, may be employed, or 

R.—Sodii bicarb 3J.(4.0). 

Tinet. nucis vom f.5J (4.0). 

Tinct. cardamom! q. s. ad f^iij (,90.0). — M. 

S. — Teaspocraful 1 4.0) before each meal. 

If the symptoms be uremic, a hot pack may be found of service, 
unless contraindicated by advanced depression and systemic weakness. 
Even in the presence of these symptoms it may be advisable to resort 
to these measures, protecting the patient against depression by a hypo- 
dermic injection of strychnine. 



INCONTINENCE OP URINE. 

Incontinence of urine may be classified either according to its forms 
or the methods of its treatment. 

Four varieties may be recognized as occurring separately, although 
all of them may occur in one case. There are cases where the bladder 
fails to hold the urine day or night, those in which the incontinence 
is only nocturnal, and those in which it occurs only upon some ner- 
vous start or in which the sphincter becomes relaxed from general 
atony. The first of these occur in children, the last in adult females. 
A fourth form of incontinence depends upon paralysis arising from 
centric nervous disorder or from paralysis due to retention and conse- 
quent paralytic distention. 

Taking up the consideration of the first forms — namely, those 
occurring in children, in which the trouble is generally nocturnal — 
the complete history and the present condition of the case must be 
discovered. Many of the most obstinate cases will yield when the 
urine is made constantly clear and mild by the use of alkalies, and 
others will recover upon the removal of worms from the vagina, which 
have crawled there from the rectum, or upon circumcision of a redun- 
dant prepuce, particularly if this be tight and smegma and urine be 
found back of it in large or small quantity. The cause of the incon- 
tinence in both these conditions is reflex irritation of the bladder-walls, 
by irritation at the end of the penis or in the vagina, and the rea- 
-"ii that alkalies do good is that they render the urine, which is con- 
centrated and irritating, dilute, alkaline, and mild. Belladonna in 
these cases is rarely, if ever, curative, and is at most only palliative, 
the condition returning as soon as the passing off of the effects of the 
drug permits the irritation to be felt by the nerves of the bladder. 
After alkaline diuretics have been used belladonna is. however, very 
valuable. 

Where the urine is concentrated and dark in color the following 
prescription is always useful : 

K. Potassii citratis Zss (2.0). 

Spt eetherifl oitrosi fkj (4.0). 

Aqua? q. s. ad f^j (30.0). — M. 

I »• ssertspoonful (8.0 every lour hours id as equal quantity of water. 



INCONTINENCE OF URINE. 667 

As the urine becomes clear after several days a few drops of tincture 
of belladonna may be added to the mixture ; but if a moderate amount 
is not sufficient, it must not be increased, as belladonna will not cure 
the condition, and may make the urine concentrated — a condition 
directly opposed to that which is wanted. 

In other instances — and these are by no means rare — the urine is 
concentrated and ammoniacal in odor. Under, these circumstances 
one of two drugs may be used with advantage, namely, urotropin in 
the dose of 4 grains (0.3) in half a glass of water three times a day ; 
or benzoate of ammonium, given in the same quantity in capsules 
after meals. Both of these drugs acidify the urine and render it anti- 
septic, and for obvious reasons are harmful if the urine is already acid. 

Sometimes these cases are dependent not so much upon vesical 
irritability as upon weakness of the spinal centres governing the 
bladder. If this be the case, the urine should first be rendered mild 
and then remedies should be directed to the improvement of these parts. 
The following pill or the succeeding solution should be administered : 

R. — Acid, arsenosi gr i (0.02). 

Extract, nucis vomicae gr. ij (0.1). — M. 

Ft. in pil. No. xx. 
S. — One three times daily after meals for a child of eight or ten years. 

Or, 

R. — Liquor potassii arsenitis gtt. xxiv (1.6). 

Tinct. nucis vomicae gtt. xvj (1.0). 

Aquae q. s. ad f^iij (90.0). — M. 

S. — Teaspoonful (4.0) three times daily after meals for a child of eight or ten years. 

This mixture is so bitter as to be exceedingly disagreeable, and 
Fowler's solution may often be used alone in the dose of ^ to 1 minim 
(0.025-0.05), and at the same time strychnine in gelatin- or sugar- 
coated pill or granule. 

It must be remembered that this last treatment is only to be 
employed in chronic cases devoid of all irritation and dependent upon 
atony. It will not do good if the urine is not previously made clear. 

Nothing can be more unfortunate in the treatment of these cases 
than punishment by severe scolding or whipping the child, as they 
never do good, and, the fault being beyond the child's control, the 
unjust punishment makes him sullen, or through nervousness, aug- 
mented by such treatment, his trouble becomes worse. In some cases 
it may be necessary, in order to cure the habit, to let the child drink 
diuretic waters for years. The patient should always be taken up from 
bed when the parents retire for the night and made to evacuate the 
bladder. 

For the incontinence of adult females or males on laughing or sud- 
den movement nothing compares, from a curative point of view, to 
drop doses of tincture of cantharides three times a day, the urine 
being kept flowing freely from the kidneys by means of alkaline 
diuretics. 

The treatment of the fourth form of incontinence of urine comes 
into the province of surgery. The bladder must be relieved by the 
catheter if the trouble be from retention with distention. If the dis- 



668 DISEASES. 

order is due to paralysis, nothing can be done except to carry out those 
general measures valuable in such cases — to maintain the urine in as 
normal a state as possible, to frequently catheterize with an aseptic 
catheter, and to -wash out the bladder every few days or hours, as the 
case may be, with some weak antiseptic fluid, such as the 1 : 10.000 
solution of bichloride of mercury, or 1 : 200 of carbolic acid, or 1 : 100 
of boric acid. 



INDIGESTION (GASTRIC AND INTESTINAL). 

Under the heading "Biliousness'* the writer has already described 
many of the conditions arising out of indigestion, and, this being the 
case, the consideration of that state known as dyspepsia or indigestion 
will only receive attention at this point in so far as its cure is con- 
cerned, without the relief of the symptoms produced. 

Lack of gastric digestion depends for its existence upon a very 
great number of causes, and is always a symptom, not a disease. It 
occurs during the course of short or prolonged fevers from atony of 
the gastric walls and glands, from lack of secretion of the proper 
character, from hypersecretion of mucus by the mucous glands, or as 
the result of any one or all of these conditions, and, lastly, because 
the food is unsuitable to the case, or is of a kind difficult of assimi- 
lation, or is readily split up into effete products by fermentation, and 
these in turn, being absorbed, produce toxic symptoms. Sometimes 
it is due to organic changes in the abdominal viscera, as carcinoma 
or ulcer, and sometimes to acute or chronic gastritis. In each of these 
states the treatment is, of course, different, because widely separated 
causative factors must be removed. 

The indigestion attendant upon the course of fevers can nearly 
always be avoided by a proper diet and the use of predigested food, 
such as pancreatized beef-tea, milk, or broths. The necessity of this 
artificial digestion is the more readily recognized when we recall the 
investigations of Hoppe-Seyler upon the quality of the gastric juice 
of a patient suffering from typhus fever, for he found that no hydro- 
chloric acid was present. Uffelmann has also found in a similar study 
that the peptone-forming secretion of the stomach ceases entirely 
during fever. 

Where indigestion results from the presence of gastric catarrh the 
remedies applicable to such a state must be resorted to. (See Gastric 
Catarrh. ) 

The -indies made within recent years upon the chemical conditions 
of the gastric contents have changed our methods of treatment from 
being empirical to being rational, for we now know that disorders of 
digestion depend on deficient or e.xeessive acidity of the gastric juice, 
deficient formation of pepsin, deficient- motility of the gastric walls, 
and other less important causes. Before carrying out any line of 
treatment the physician must therefore decide, if possible, as to the 
underlying cause of the dyspepsia found in each case, and his decision 
may be based on well-described subjective symptoms by the patient, or 



INDIGESTION. 669 

upon this description aided, or it may be replaced, by examination of 
the stomach-contents after a "test-meal." 

In those cases in which the dyspeptic symptoms result from imper- 
fect mastication and insalivation of food it is evident that careful 
eating rules are to be given the patient, with the additional advice, 
which is equally good in all cases, that exact meal-hours shall be 
adhered to, since irregularity in meal-hours results in imperfect diges- 
tion as commonly as irregularity of habit in regard to defecation 
results in constipation. If the dyspeptic symptoms are due to deficient 
secretion of gastric juice, particularly if it is found that hydrochloric 
acid is the chief deficient element, one of two plans presents itself 
for employment. In many cases it will be found that the administra- 
tion of small doses of bicarbonate of sodium, 5 to 10 grains (0.3-0.65), 
before each meal will cause a free secretion of gastric juice, particu- 
larly if it be given simultaneously with bitter substances which act 
as stimulants to the gastric mucosa. These facts are not based solely 
on the apparent improvement in the patient, but also upon careful 
chemical studies of the acidity of the gastric juice by means of the 
stomach-tube. In mild cases the taking of a glass of imported Celestin 
Vichy water before each meal serves to provide sufficient sodium to 
produce good effects. The bitter substances which it is best to employ 
in cases of deficient acidity of the gastric juice are among the simple 
bitters, such drugs as quassia, cascarilla, Colombo, and gentian. Among 
the peculiar bitters we have nux vomica, quinine, rhubarb, and con- 
durango. These may be employed in the following forms : 

R. — Sodii bicarbonatis ,^j (4.0). 

Tinct. nucis vomicae f^j vel. ij (4.0 vel 8.0). 

Tinct. gentian, comp. . . q. s. ad fljiij (90.0). — M. 
S. — Teaspoonful to a desertspoonful (4.0 to 8.0) before meals. 

If the stomach is lazy and atonic, but with no true disease which im- 
pairs its secreting power, an alkali will, in the majority of cases, prove 
to be the best drug ; but if, on the other hand, there is deficient gas- 
tric secretion through atrophy of the gastric tubules or carcinoma of 
the stomach, the use of hydrochloric acid is the better plan. Under 
these circumstances the following prescription may be ordered : 

R.— Acid, hydrochloric, dil f.^j vel f^iv (4.0-15.0). 

Ext. condurango fl f.^j (30.0). 

Tine, cardamomi comp q. s. ad f^iij (90.0).— M. 

S —Dessertspoonful (8.0) with or after each meal in water. 

The symptoms manifested by persons needing the treatment first 
named are variable, but generally of sufficient constancy in type to be 
fairly pathognomonic. There is generally loss of appetite, some 
impairment in general health and nutrition, and marked difficulty in 
digesting food, particularly if it be in solid form. Complaint is usually 
made of a sensation of weight after eating, without any real pain, 
but indigestion is not complete, owing to the food being finally dis- 
posed of in the duodenum. Often because of the delay in gastric 
digestion there is some belching of gas due to fermentation of the 



670 DISEASES. 

food in the presence of warmth and moisture, and without the anti- 
septic influence of the gastric juice. If any food is brought up with the 
belching, it is unaltered or changed only by fermentation. Examina- 
tion of the stomach-contents for hydrochloric acid by the phloroglucin- 
vanillin test will speedily confirm the diagnosis of absence of hydro- 
chloric acid, and this confirmation should be sought for in every case. 

In the cases of gastric indigestion depending upon hypersecretion 
of the acid of the juice a line of treatment quite at variance with that 
just discussed must be instituted. This may be divided into the 
direct and indirect forms, including the remedies which distinctly 
decrease gastric secretion and those which antagonize or overcome its 
acidity after it is poured out from the glands. In the first-class we 
find both general and local nervous and glandular sedatives, and in the 
second alkaline drugs. 

Of the first class we have hyoscyamus, belladonna, and opium 
from the vegetable kingdom, and the bromides, bismuth, and nitrate 
of silver from the mineral. Of the second class we have massive 
doses of sodium bicarbonate taken during or after meals, ammo- 
nia, generally in the form of the aromatic spirit, and magnesia and 
chalk. 

As many, if not all, of the cases suffering from hyperacidity are 
of a nervous temperament, these drugs do good by quieting reflex 
activity throughout the nervous system connected with digestion, and 
by a local action on peripheral nerves, or on the glands themselves, 
diminish secretion. Of particular value for this purpose is hyoscy- 
amus, which very markedly decreases gastric secretion directly and 
indirectly, and at the same time relieves gastric pain by its local 
sedative influence. 

Taking gastric ulcer as a typical instance of a condition of 
excessive secretion of hydrochloric acid, it will be found that the fol-' 
lowing pill, combined with 'an absolute milk diet or, for the first few 
days, allowing only rectal alimentation by peptonized food, will be 
most useful : 

R. — Argenti nitratis gr. v (03). 

Extract hyoscyami gr. x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One pill one hour before taking food. 

Sometimes in place of this pill it is wise, particularly if no ulcer 
exists, to give 10 to 20 grains (0.65-1.5) of bromide of strontium 
one hour before meals, and in any case where this fails to control 
excessive secretion of acid full doses of sodium bicarbonate may be 
given, 20 or 30 grains (1.5 or 2.0) or more, after each meal. The 
following formula may be used: 

B — Magnesia (hydrated) giijss (14.0). 

Bismuthi subnitrat., 3u ss (10.5). 

Crete preparatje ^iijss (14.0). 

Sodii bicarbonat £iijss (14.0). — M. 

Ft. in chart. N<>. xx. 

One powder three hours after meals. 



INDIGESTION. 671 

^he bromide had better be given in solution. If the stomach is very 
irritable and there is a tendency to vomiting, a powder composed as 
follows is often useful : 

R. — Acid, carbolic, (cryst.) . rr\, xx (1.5). 

Bismuthi subnitrat. gr. cc. (14.0).— M. 

Ft. in chart. No. xx. 
S. — One t. i. d. with or before food. 

The symptoms manifested by the patients requiring this treatment 
are as follows : There is often a constant sense of gnawing or hollow- 
ness in the stomach, which is sometimes temporarily allayed by the 
taking of food. The patient is, as a rule, of a nervous temperament 
and in a condition of nervous depression due to some exhausting cause. 
Tenderness and even pain in the epigastrium may be produced by 
superficial or deep palpation, or the patient may complain that the 
pressure of his clothes is distressing. If ulcer of the stomach is 
present, all the characteristic symptoms of that lesion may be 
found. When belching occurs, there is often vomiting of sour 
masses or acid eructations or heartburn. Gastralgia more or less 
severe may also occur. Sometimes such patients are neurasthenic and 
need a rest-cure. 

In cases where testing the stomach contents shows that the exces- 
sive acidity is not due to hydrochloric acid, but to the acids of fer- 
mentation, the use of the sedative drugs we have named is of no avail 
for obvious reasons, and in their place we may employ sodium bicar- 
bonate as a palliative, and antiseptic or antifermentative drugs, such 
as thymol, beta-naphtol, creosote, chloral, and sodium hyposulphite, 
as direct remedial agents. Lavage of the stomach should also be re- 
sorted to. 

In still other cases a mixture containing chloral and hyposulphite 
of sodium is useful because of its antiseptic influence. (See Chloral.) 

Often these cases are relieved if all fats, and butter in particu- 
lar, are excluded from their diet-list. 

If much gas is developed and a sensation of weight in the stom- 
ach is felt after eating, so that the patient feels as if the food lay 
undigested in that organ, the following prescription may be used, but is 
contraindicated if the stomach is tender on deep palpation, or, in other 
words, if acute irritation or inflammation of the stomach is present. It 
is useful in atonic states of the stomach, and it is surprising how much 
relief may be afforded by the use in such cases of these prescriptions. 

K- — Oleoresin. capsici tt\,ij (0.1). 

Pepsin, vel pancreatin gr. xx (1.35). 

Carbo ligni gr. xl (2.65). 

Creosoti ... tt\,x (0.65).— M. 

Ft. in pil. No. xx. 
S. —One after eating. 

Another useful formula is : 

R. — Pulv. capsici gr. x (0.65). 

Taka diastase . . . . gr. xl (2.65).— M. 

Pone in capsul. No. xx. 
S. — One with meals. 



672 DISEASES. 

Intestinal indigestion depends upon almost the same causes as does 
gastric dyspepsia, and is to be treated in much the same manner, chiefly 
by a careful study and regulation of the patient's diet, and by the use 
of a number of remedies calculated to aid to some extent the normal 
juices by some digestive ferment. These ferments should be given 
with the meals or the food be kt predigested " before it is taken. 

The pancreatin should be given in full dose (5 to 10 grains [0.3- 
0.65]), with bicarbonate of sodium, and alkaline mineral waters used 
if the urine is concentrated and acid. (See Biliousness.) 

Sometimes where intestinal indigestion is present great flatulence 
comes on, and is an annoying symptom. Very commonly in these 
cases it will be found that the patients think they have heart disease 
because of the pain they suffer under the prsecordium. This pain is 
due to the accumulation of flatus in the small intestine, or more com- 
monly to its pressing upward at the angle where the transverse colon 
turns to go down to form the descending colon and sigmoid flexure. 
Under these circumstances the prescriptions named above will be 
found of service, or the following may be used : 

R.— Acid, nitric, dil f#j vel iij (8.0-12.0). 

Tinct. cardamom, comp f^vj (180.0). — M. 

S. — Dessertspoonful (8.0) in water four times a day. 

In some persons flatulence of the large bowel is met with, and is 
often associated with atony of the muscular coats of the gut. Under 
these circumstances the following prescriptions will be found of 
service : 

R.— Asafcetidpe gr. xl (2.6). 

Extract, nucis vomicae gr. iv (0.25). 

Extract, physostigmatis gr. iij (0.18). 

Oleoresin. capsici tt^x (0.65).— M. 

Ft. in pil. No. xx. 
8. — One pill three times a day, two hours after meals. 



Or, 



R. — Tinet. belladonna* f^Ji (8.0). 

Tinct. physostigmatis f^j' (4.0). 

Spt. camphoraa q. s. ad f^iij (9o!o).— M. 

S. — Teaspoonful (4.0) two hours after meals or whenever needed. 



Abdominal massage is a valuable aid in treating this class of cases. 
Sometimes it can be well done by directing the patient to roll slowly 
and gently a six-pound cannon-ball over the course of the colon, to urge 
on the intestinal contents and cause secretion. In other instances the 
application of a roller electrode with the rapidly interrupted current from 
a faradic apparatus is useful. 

Where intestinal indigestion results in lientery the treatment 
becomes entirely changed, except in regard to the use of a predi- 
gested milk diet, and efforts must be made to increase the secretion 
of the glands of the intestinal wall. Often minute doses of mercurv 
bichloride or podophyllin may do this, - (; 1 , r to ^ grain (0.001-0.0016) 
of the first or second, respectively. More commonly, however, the 
mixture of nitric acid, given above, will be the proper treatment, or 
perhaps the following if the liver is found to be torpid: 



INFLUENZA. 673 

R.— Acid, nitro-hydrochlor. (not dil.) . . . . f.^ss veFfgj (2.0-4.0). 

Jnfus. gentianse comp q. s. ad fgvj (180.0).— M. 

S.— Dessertspoonful (8.0) every four hours or after meals, in water. 

Chloroform spirit is often valuable in some of these cases in the 
dose of 20 minims (1.3). (See Chloroform.) 

INFLUENZA. 

The disease known as influenza affects various individuals so 
differently, and presents so many symptoms associated with functional 
disorder of various organs in the body, that it is almost impossible to 
do more than consider the remedies which are to be employed in the 
treatment of the more frequent or more immediate manifestations or 
complications. Greater in importance than the employment of drugs 
must be regarded continuous rest, and stimulants are in many cases 
absolutely essential. 

In those cases in which the disease is ushered in by a severe chill, 
accompanied by violent pains in the back, if the patient is seen early 
enough it may be necessary to employ remedies for the relief of the 
rigor, with the double purpose of improving the patient's general con- 
dition and preventing internal congestion of vital organs. In the 
majority of instances, however, the patient will not be seen during 
this period of the disease, but during the febrile stage, which succeeds 
that just mentioned. Under these circumstances the author does not 
believe that it is well for the physician to resort to any of the rem- 
edies which have been so largely used during the last few years, and 
which are known as the w ' antipyretics " or the derivatives of coal- 
tar. Although originally introduced for the purpose of reducing 
febrile temperatures, practical experience has taught us that their 
value is very limited under these circumstances, and the author 
almost never gives antipyrin, phenacetin, or acetanilid with the 
object of reducing fever. Although he does not believe that these 
remedies are to be used for the reduction of temperature, he has 
certainly seen very marked relief follow their employment with 
the object of subduing the severe pain which occurs in the back, 
limbs, or head. Small doses are usually sufficient to at least reduce 
the suffering, if not to remove it entirely, but, as cardiac complica- 
tions are by no means unusual, large doses are contraindicated in 
most persons. The author prefers to allow the patient to suffer from 
a moderate degree of pain rather than from the dangers incident to 
the administration of doses large enough to entirely relieve it, because 
in his experience these doses have to be very large if they are to be 
entirely competent as analgesics in influenza. 

If any of the coal-tar products are used either for the relief of 
fever or of pain, phenacetin and acetanilid should be chosen. Ex- 
periments made in America and in Germany on animals have proved 
that phenacetin is far less toxic in its relations to the heart than is 
antipyrin or acetanilid, and while it has in a number of instances 
seemed more apt to produce cyanosis in man than other drugs, this 
cyanosis rarely, if ever, has been associated with any other danger- 

43 



674 DISEASES. 

ous symptoms. Indeed, it is quite extraordinary the amount of 
cyanosis which phenaeetin may produce without the respiration be- 
coming greatly disordered, very much less cyanosis when caused 
by acetanilid or antipyrin being accompanied by much more alarm- 
ing symptoms. A very favorite combination with practitioners who 
have had a large experience is one of salol and phenaeetin. The 
action of the phenaeetin in relieving the pain and in reducing the 
fever seems to point to it as a rational remedy, but the exact in- 
fluence of salol under these circumstances is not so clear. Com- 
posed, as it is, of 60 per cent, of salicylic acid and 40 per cent, 
of carbolic acid, it seems to possess a therapeutical power different 
from that possessed by either of these two constituents alone, for 
neither carbolic acid nor salicylic acid has much power in the relief 
of pain when used alone, unless, as in the case of carbolic acid, it 
is applied directly to the part affected. Perhaps the condition of 
pain in the lumbar and other muscles during the attack of influenza 
is in some unknown way associated with the condition which we 
have called " rheumatism," and in which salicylic acid does good 
in an unknown manner. Salicylic acid alone might be equally use- 
ful if it Avere dissolved in the intestine and did not irritate the 
stomach. 

On seeing a case of influenza during the first few hours of the 
attack the author resorts to those remedies which have been in use 
by the profession for many years, and, so far as he can learn, it is 
the custom of other members of the profession to give a mixture 
composed of tincture of aconite, spirit of nitrous ether, and a solu- 
tion of citrate of potassium in preference to any other medicine at 
this time. This mixture possesses the advantage of increasing the 
action of the skin and kidneys, and of reducing the temperature, of 
quieting the circulation, and of being readily taken by the patient 
without danger of disordering the stomach at this time or later on, 
which is important, as this organ is apt to become irritable. As a 
general rule, citrate of potassium is given in too small doses, and, 
unless there are reasons to the contrary, it should be given in the dose 
of 10 to 15 grains (0.65-1.0) three times a day to an adult. 

If the fever becomes excessive, so that there is danger of the 
patient suffering from a true hyperpyrexia, it is better to resort to 
cold bathing instead of the antipyretics just spoken of. . It is true 
thai the patients themselves and the friends of the patients will some- 
times protest against what they deem an heroic measure, but the 
an t hoi- is satisfied that if the cold is used in the proper manner it is 
devoid of danger to the patient. The majority of physicians do not 
-••(■in jo carry out the treatment of Brand and Liebermeister as it is 
carried out by its originators. Most of them forego the very import- 
ant portion of the treatment, which consists in frictions designed to 
bring tin- heated blood to the surface, and the author has again and 
again seen physicians apply cold either by means of a wet sheet, by 
Bponging, or a cold hath without using any measures which are di- 
rected ;i L r;ii]i^t internal congestion. (See Cold and Fever.) 

Hyperpyrexia in influenza does not seem to possess the same dangers 



INFLUENZA. 675 

that it does in the course of some other diseases. In the first place, as 
a general rule, the course of the disease is a brief one, and, although it 
may leave the patient weak and exhausted, the duration of the febrile 
portion of the malady does not extend beyond a few days. Clinical 
experience and physiological study have proved that it is not the tem- 
perature of 105° or 106° F. which is distinctly dangerous, but the 
continuation of this temperature for many hours which is harmful. 
Similarly, a patient ill from typhoid fever, having a temperature of 
103° for many days, is injured very much more than is a patient who 
is suffering from pneumonia, and who may have for forty-eight hours 
a temperature of 104.5° or 105°. For these very reasons a tempera- 
ture of 104.5°or 105° is not particularly alarming in the condition 
which we are considering, unless there are symptoms pointing to the 
fact that the patient is being injured by an excessive temperature, as 
may be indicated by somnolence and an exceedingly dry skin as well 
as cerebral symptoms. Of course, if renal trouble, associated with 
cardiac disease, comes. on at this time, methods for the reduction of 
the temperature must be resorted to. The point to be strongly 
emphasized is that the mere existence of high temperature is not to 
be regarded as a condition to be overcome by the use of drugs. 

It seems to be the general consensus of opinion, both in America 
and in England, that any measures of a depleting character are dis- 
tinctly harmful in influenza, even at its earliest stages, and we would 
naturally expect that this would be the conclusion arrived at by phy- 
sicians who treat their patients rationally. Although influenza is a 
short-lived disease, there is probably no malady in which the patient 
goes so quickly into a condition of profound depression, or even exhaus- 
tion, as in this one. The abstraction of blood from a vein or by the 
use of cups should not be resorted to, as it will increase the exhaustion. 
Before the system has a chance to recover from the onset of the attack 
it will be still further depressed by the therapeutic measures of the 
physician who is unwise enough to bleed. 

As the case of influenza progresses a condition of marked depres- 
sion, or even collapse, very frequently develops. The expression of 
anxiety on the patient's face is to a physician who is accustomed to 
see it in other diseases a most alarming symptom, and it is not until 
one has seen it repeatedly in influenza that he is able to give it its 
exact value. Associated with this condition, the skin is frequently 
covered with a profuse perspiration, and the pulse is very apt to be 
very rapid, running, feeble, and easily compressed. At first glance 
the old saying, that "we treat the symptoms as they arise," would 
seem to cover to a very large extent the indications which are present 
at this period ; yet the author's experience, which may differ from that 
of some of his readers, is that the cardiac stimulant which we are 
most frequently accustomed to use — namely, digitalis — does not seem 
to take hold of the circulatory apparatus and to act upon it in the 
manner which is desired. It may be that the pressing symptoms 
have made us more anxious and impatient as to the use of any medi- 
cament, and that we have not had the patienca to wait and allow such 
a slowly-acting remedy as digitalis to take effect. Be this as it may, 



676 DISEASES. 

the author regards strychnine as infinitely preferable to foxglove 
when these symptoms appear ; and he has been able to prevent 
their appearance, or at any rate to modify them to a very great 
extent, by using strychnine in full doses from the first portion of the 
stage of depression. We believe that, as a general rule, strychnine 
is given in very much smaller doses than safety requires, and that in 
many instances it fails to act because the doses are too small to strug- 
gle with the profound condition of exhaustion which is present. In 
an adult we can see no reason why ^- of a grain (0.003) may not be 
given three or four times in twenty-four hours, and in some cases we 
have given it every four hours without producing any of the symp- 
toms of an overdose of strychnine. Divided doses are better than a 
few very large ones. 

The author knows of no better illustration of the fact that in some 
conditions we are to give drugs for effect rather than according to 
customary dose than the employment of strychnine in influenza, and 
the physician who is timorous in the presence of this frequent com- 
plication, depression, certainly increases the patient's danger. As 
with everything else, the drug should be carefully watched, and at 
the first sign of muscular twitching or stiffness at the back of the 
neck its administration should be cut down or discontinued. In 
many instances where the collapse comes on suddenly the strychnine 
should be administered hypodermically and followed by full doses by 
the mouth, in order to keep up the full effect exercised by the drug 
upon the nervous and circulatory systems. In some cases it will be 
found that the blood-paths seem to be so relaxed and atonic that the 
strychnine is unable to produce a sufficient vascular effect to bring 
the patient out of his difficulties, and under these circumstances very 
good results follow the combination of belladonna with strychnine, 
the belladonna being, as we well know, a powerful vasomotor stim- 
ulant under such circumstances. It also should be given in full doses 
for effect. As the acute stage of depression passes off the belladonna 
should be stopped and the strychnine continued alone through con- 
valescence. It is proper to point out, however, that strychnine is not 
a drug suitable for the purpose of producing constant stimulation. It 
is a whip to the nervous system, and if used in too large a dose for too 
long a time the overwhipped system fags out. 

Alcohol has not seemed to be of much value during the active 
period of the disease. In milk-punches and eggnogs it is of course 
useful during convalescence. 

If del iiium comes on, it has not seemed to be a symptom of very 
serious character either for immediate results or in influencing the 
prognosis as to the ultimate recovery of the case, and in cases of 
pneumonia complicating la grippe, in which delirium is the prominent 
symptom, ii appears that delirium is not to be regarded in the same 
lighl as similar manifestations complicating ordinary pneumonia or 
other diseases. The delirium may be either talkative or muttering, 
bni does not in the majority of cases require treatment, passing away 
with the fever and rarely extending into the stage of exhaustion. 

For the irritative cough steam inhalations, laden in the first stage 



INFLUENZA. 677 

with benzoin or other innocuous and sedative substances, seem par- 
ticularly useful. For the bronchitis which is often present it is gen- 
erally sufficient to administer the ordinary mixtures, containing ipecac 
and potassium citrate, in the earliest stages, and to follow them by 
chloride of ammonium and cubebs in the later stages. The author 
does not think that the compound liquorice mixture containing anti- 
mony should be given in the second stage of influenza. A complica- 
tion too apt to occur at this time is oedema of the lung or a wide- 
spread bronchitis, with a profuse exudation which bids fair to drown 
the patient in his own secretions. Antimony is not only a substance 
depressing to the circulatory and respiratory systems, but aids very 
materially in causing the peculiar excess of secretion which has just 
been spoken of. 

It may be necessary to use bromides if the cough is excessive, or 
to replace them by codeine or very small doses of morphine. In many 
cases still better results will be obtained by a good preparation of 
cannabis indica, which may be pushed until it relieves the cough with- 
out in any way endangering the patient's life — a safety which cannot 
be obtained by the employment of any other of the drugs named. 

If sleeplessness is so pressing a symptom as to require attention, 
the bromides may be given, but it will be generally found that the 
insomnia comes after the attack rather than during it, or in any event 
it will not require attention until the patient is convalescent. Under 
these circumstances chloral or chloralamide, or even sulphonal, may 
be administered, care being taken, of course, in the case of chloral 
that the cardiac apparatus is in good condition, and in the case of 
sulphonal that it is administered in a powdered form or dissolved in 
hot water and given four or five hours before the time at which sleep 
is desired. 

For the vertigo and dizziness which are sometimes bitterly com- 
plained of by the patient either during or after the attack, small doses 
of bromide with ergot or cannabis indica have seemed particularly 
valuable, probably because they exercise some effect upon the blood- 
vessels of the brain or its membranes or perhaps upon the blood-ves- 
sels of the ear. Certain it is that in those cases of tinnitus not asso- 
ciated with organic change in the aural canals bromides and ergot do 
more toward relieving them than any other medication. 

In the constipation which is sometimes present in the early stages 
of influenza it is generally advisable to administer either castor oil 
or in other cases \ ounce (16.0) of the sulphate of magnesium, or 
for more fastidious patients the citrate of magnesium. A full purga- 
tive effect of any of these salines seems to lessen the fever when the 
bowels are unloaded. Care should be taken that the dose of the purga- 
tive is not excessively large, as it will weaken the patient as much as 
would bleeding. For the constipation following the attack probably 
no drug is as efficient as cascara sagrada, combined perhaps with 
aloin. (See Constipation.) If diarrhoea supplants the constipation, 
the ordinary astringents, such as aromatic sulphuric acid or haematox- 
ylon, will be found sufficiently active. (See Diarrhoea.) 



678 DISEASES. 



INSOMNIA. 



Insomnia is a condition complicating many diseases, and arises from 
such a host of causes that the physician may not be able to discover 
them for some days after the patient is first seen. As a general' rule, a 
patient consulting a physician with this symptom expects a prescription 
to be given at once and the cause of the insomnia found out afterward. 
Under these circumstances the physician may safely employ several 
drugs according to the information that he has concerning the patient's 
state. 

One of the most common remedies is chloral given in the following 

manner : 

R.— Chloralis ^iij (12.0). 

Syrup . . ■ f£iv (16.0). 

Aquse cirmamomi q. s. ad f^iij (90.0). — M. 

S. — Dessertspoonful (8.0) at night. 

Or, 

R.— Butyl chloral-hydrat 3J (4.0). 

Ft. in pil. No. xii. 
S. — One, two, or three pills at night, as needed. 

Where, for any reason, as the presence of a weak heart, chloral 
is contraindicated, resort may be had to the bromide of potassium 
or sodium, and if the patient is a female these drugs should always 
be accompanied by a small dose of arsenic, generally in the form of 
Fowler's solution, 1 to 3 minims (0.05-0.15) three times a day, in 
order to avoid all danger of the production of acne. The following 
prescription is useful : 

R. — Potassii bromid ^ij (8.0). 

Liq. potassii arsenit fgss (2.0). 

Aqua; cinnamomi q. s. ad f§vj (180.0). — M. 

S. — One to two dessertspoonfuls (8.0-16.0) at night. 

In many cases larger amounts of the bromide will be needed. 

Where the sleeplessness is due to pain, chloral is of little value and 
bromides are worth but little more. Under these circumstances by 
resorting to what is known as the " crossed action of drugs," we can 
often obtain a very good effect. Thus morphine and chloral both act 
on the brain to produce sleep, or, in other words, their action is here 
crossed, for one relieves pain and the other does not; one kills by 
failure of the heart in overdose, the other by respiratory failure; as 
a consequence, large doses of neither can be given alone. The fol- 
lowing is therefore a useful combination, either where one drug fails 
or when dangerously large doses of either alone have to be used to 
obtain the desired result: 

R. — Morphinse sulphatis gr. iv (0.2). 

Chloralis spj (8.0). 

Syrup fs-'ij (60.0). 

Aquae q. s. ad f^iv (120.0).— M. 

S. — Dessertspoonful (8.0) at night. 

In cases where insomnia is due to mania hyoscine is said to be very 
useful, given in the dose of j-J-^ to J$ grain (0.0007) by the mouth 



INSOMNIA. 679 

or -^-Q or y^q grain (0.0006) by the hypodermic needle. Owing to its 
tastelessness the powder may be put on the tongue, and it is best to 
order a little sugar of milk or white sugar (1 grain) to be added to 
each dose of hyoscine, in order to give it bulk. 

Where insomnia follows mental effort avoidance of all cerebral 
activity should be insisted upon during the evening, and if the feet are 
cold on going to bed sleep should be induced by relieving tht cerebral 
congestion by a hot foot-bath or the use of a hot-water bag at the feet 
while cold is applied to the head. In other instances a general hot 
bath, during which an ice-bag is applied to the head, will produce sleep 
when drugs fail, and it is to be remembered that in the insomnia of 
convalescence and neurasthenia hydrotherapeutic measures are to be 
used to the exclusion of drugs (see Cold and Heat), for the former cure 
the condition, while the latter only palliate, and may produce a drug- 
habit. 

During the last few years a very large number of remedies have 
been introduced as hypnotics, such as chloretone, somnal, paraldehyde, 
chloralamide, sulphonal, trional, amylene hydrate, hypnal, and others. 
Of these the best, from every point of view, are sulphonal, trional, 
and chloretone. The dose of sulphonal and trional is 10 to 20 grains 
(0.65-1.3) in powder, but, as they are large in bulk and hard to swal- 
low, they should be used in a prescription made up as follows : 

& .—Sulphonal gr. xxx (2.0) 

Syrupi simplicis f^ij (8.0). 

Mucilaginis acacise f^ij (8.0). 

Aquae destillat q. s. ad fjj (30.0).— M. 

S. — Half to all of this at one dose, as may be needed. 

In other instances sulphonal may be dissolved in very hot water or 
milk, and the solution swallowed before it cools sufficiently to permit 
precipitation. 

In ordinary nervous insomnia or that due to heart disease chloretone 
often acts very efficaciously in the dose of 10 to 20 grains (0.65-1.3) 
in tablets or capsules of 3 to 5 grains (0.15-0.30) each. 

Chloralamide may be used in the dose of 15 to 60 grains (1.0-4.0), 
dissolved in wine or given in capsule. Paraldehyde is given in the 
dose of 20 to 60 minims (1.3-4.0). As it is disagreeable in odor and 
taste, it must be given in capsule, and it is very apt to disorder the 
stomach. 

The dose of amylene hydrate is the same as that of paraldehyde. 
It is a liquid, and, like the rest of the drugs named, with the excep- 
tion of hypnal, has no effect in insomnia from pain. 

Somnal is used in the dose of 10 to 40 minims (0.65-2.65) with 
liquorice and water, and possesses considerable power. 

In the treatment of insomnia it should be remembered that if pos- 
sible those drugs should be used which will quiet the part of the brain 
which is most active. Thus if the patient tosses much, we use bro- 
mides and chloral as motor depressants. If sensation is active, bro- 
mides and the hot pack are used to act as sensory quietants. 

In some cases horseback exercise taken late in the afternoon does 



680 DISEASES. 

good, particularly if the patient follows a sedentary life. Many per- 
sons who are usually sleepless will obtain a refreshing slumber by 
taking a very light and easily digested meal just before retiring for 
the night or by eating a cracker or drinking a glass of milk when 
they awake during the night. 

In some instances sleeplessness arises from acidity of the stomach, 
and is put aside by the use of bicarbonate of sodium. 

INTERMITTENT FEVER. 

It having been proved that malarial fever in man is practically 
always the result of the bite of a mosquito, Anopheles quadrimacu- 
latus, the disease is to be prevented by destroying mosquito-breeding 
pools and protecting the skin. 

In all forms of intermittent fever, whether the attacks are quotidian, 
tertian, or quartan, the best remedy for their prevention is quinine, 
which should under these circumstances be given about two or three 
hours before the attack is expected, so as to be absorbed and be 
physiologically active when the paroxysm is due. This precaution 
is- often overlooked, and the dose ordered at the time of the expected 
attack, with failure as a result. Not only should sufficient time 
elapse for absorption, but the fact should be remembered that the 
chill often begins an hour earlier each day, and will be in full sway 
before the quinine can stop it if the drug be not administered at the 
proper time. 

There are two methods of giving quinine in malaria. In one it is 
given just before an expected paroxysm, to prevent it by destroying 
the parasite at the time of maturity. In the other plan the drug is 
administered in the sweating stage, not because it will have any valu- 
able influence on that particular paroxysm — which is nearly over — but 
in order that it may destroy the young spores which are floating free 
in the blood-stream and about to attack corpuscles, in which they will 
mature. Undoubtedly if the quinine is given at the proper time before 
an attack it not only tends to prevent the oncoming paroxysm, but 
future ones by its influence upon the mature and immature parasites. 
If, therefore, the patient is seen before the attack, he should receive 
quinine to prevent or modify it. If seen after an attack is well 
advanced, he should receive a dose to prevent the next attack by 
destroying the crop of parasites set free in the blood during the 
paroxysm just passed. When the physician sees the patient during 
an intermission the following plan of quinine medication is wise : If 
the infection be due to the tertian organism, which causes an attack 
every forty-eight hours, the quinine should be given every alternate 
day in full dose, as already described. If* there be a double infection 
with this organism, so thai the attacks occur daily, then the full dose 
must be given daily. If the quartan parasite, or that which matures 
every seventy-two hours, is the cause of the attack, then the full dose 
of quinine should be given on the day of the expected attack long 
enough before to he absorbed, and smaller doses between the attacks 
to maintain a quinine influence. If, however, there be a double 



INTERMITTENT FEVER. 681 

quartan infection, then the attack occurs on two consecutive days 
with a third day free. Here the quinine is needed on the two severe 
days and only in small doses on the intervening day ; or if there be 
a triple quartan infection, it is used every day in full amount to 
antagonize each set of parasites as they mature. 

Very much smaller doses of the quinine will be needed if the patient 
rests in bed than if he is up and about. 

Experience has proved that quinine never acts as favorably if con- 
stipation is present as when the bowels are lax, and hepatic activity 
seems particularly necessary for its full effect. To obtain the full in- 
fluence of the drug it should be preceded, by some four or five hours, 
by \ to \ grain (0.010-0.016) of calomel every fifteen minutes until a 
grain (0.05) is taken, or by a dose of podophyllin amounting to -^ to 
■1- grain (0.006-0.008). If podophyllin is used, a longer time should 
be allowed, because of the slow action of this purgative, and if the 
patient has been rendered unusually insensitive to purgatives, larger 
doses of both the remedies named must be used; particularly is this 
true in the South, where 5 to 20 grains (0.3-1.3) of calomel are 
often used. 

The dose of quinine varies with the exigencies of the case, which 
in turn generally depend upon the region in which the patient lives 
or has lived. 10 to 15 grains (0.65-1.0) in one dose are generally 
sufficient in the Eastern and Northern States, but as much as 20 to 
45 (1.3-3.0), or even 60 grains (4.0) may be required in the south- 
ern parts of the United States and elsewhere. When still larger 
doses are employed, the drug should be given partly hypodermically 
and partly by the rectum in suppository or in solution, as well as by 
the stomach, as this viscus will rarely withstand 60 grains (4.0) of 
quinine without irritation. (For the best salts for hypodermic use, 
see article on Cinchona.) If the stomach is irritable, resort to these 
means of entrance into the body are absolutely necessary and must be 
entirely relied on. 

Having considered the prophylaxis of a chill, let us turn to the 
treatment of the attack itself. It must be remembered that the 
greater part of the harmful effect of the malarial poison is exerted at 
this time by the internal congestions and engorgement of the abdom- 
inal and thoracic organs. The physician should therefore try to pre- 
vent, as far as possible, too great a rigor, and if stasis results from 
the chill, overcome it, not by depletants, unless the case is very 
sthenic, but by stimulants, such as strychnine or digitalis, which will 
drive out the blood from the congested area. 

If a full meal has just been eaten, the stomach should be emptied 
by an emetic dose of ipecac, 2 drachms (8.0) of the powdered drug 
to an adult, or by 20 grains (1.3) of sulphate of zinc. It is almost 
useless to give quinine at this time, as absorption from the stomach 
and subcutaneous tissues is almost entirely absent. Alcoholic stimu- 
lants are not to be employed, as clinical experience seems to indicate 
that they act unfavorably. 

If the chill is severe enough to endanger the patient's life, meas- 
ures must be used to control it. Chloroform may be inhaled, and 



682 DISEASES. 

immediately preceded by laudanum by the bowel or mouth. If the 
laudanum is given by the mouth, a little ether or chloroform may be 
added to the dose of the opiate. The opium may be used hypoderm- 
ically in the form of morphine in the dose of -^ of a grain (0.01) com- 
bined with J-j of a grain (0.001) of atropine. 

In the fevered stage little can be done except to give the patient 
comfort by cool drinks and cool sponging, or, if the fever becomes 
excessive, by the use of ice-cold sponging with active friction. These 
measures have seldom to be used, as the fever is generally too fugitive 
to need such treatment. 

The sweating stage needs no particular treatment, unless exhaus- 
tion is caused by it, when stimulants may be cautiously used as 
needed, and large draughts of water at ordinary temperatures swal- 
lowed. 

Many measures have been resorted to to put off a malarial attack, 
the chief of Avhich is the use of ether or chloroform anaesthetization 
at <:he time of the expected paroxysm, of nitrite of amyl or of the 
nitrite of potassium or sodium in 10-grain (0.65) dose for the same 
purpose. Where the " chill habit" exists and depends largely upon 
nervousness, it has been broken by misplacing the hands of the clock, 
and so getting the patient past the time for his attacks without his 
knowledge. 

It should be remembered that the use of quinine in malarial 
fevers is no longer based on empiricism, but upon the fact that the 
drug exerts a peculiarly lethal influence over the cause of the dis- 
ease, the Plasmodium malaria? of Marchiafava and Celli, or, as it is 
sometimes called, the malarial germ of Laveran or the haematozoon 
of malaria. 

It is worth remembering that methylene blue possesses antimala- 
rial properties in the dose of 1 to 4 grains (0.05-0.2). (See Methyl- 
ene Blue.) 

IRITIS. 

Iritis, or inflammation of the iris, as usually encountered is caused 
either by syphilis, rheumatism, or gout. It may also be traumatic: 
less frequent causes are gonorrhoea, diabetes, malaria, and tuberculo- 
sis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The 
most marked symptoms are severe brow pain; fine ciliary injection; 
discoloration of the iris and immobility of the pupil, due to the for- 
mation of adhesions between the iris and the capsule of the lens. 
The most important local remedy is atropine, to be used every two 
hour- according to circumstances. If for any reason this is not 
tolerated, duboisine, scopolamine, or daturine may be substituted. 

line increases the mydriatic power of atropine. 

Pain may be relieved by leeches to the temple and the use of dry 
heal externally (cotton batting heated over a register will suffice) or 
liot fomentation water, chamomile infusion, or laurel-water (1: 15). 

In traumatic iritis iced compresses are suitable in the early stages, 
but not in the later periods and not in any other form of iritis. Great 



KERATITIS. 683 

care must be taken not to mistake iritis for conjunctivitis on the one 
hand, and glaucoma for iritis on the other ; delayed use of atropine 
and the employment of astringents on account of the former error, 
or the instillation of atropine because of the latter, would constitute 
a serious therapeutical blunder. In serous iritis, or that variety in 
which there is a hypersecretion of the aqueous humor, which becomes 
turbid, and a precipitate of dark spots occurs upon the membrane of 
Descemet, atropine must be cautiously instilled, owing to the tend- 
ency to increased tension. If this occurs, paracentesis of the cornea 
may be needed, and pilocarpine should be given internally if the vit- 
reous becomes opaque. 

Subconjunctival injections of sublimate (2-5 drops of a 1 : 2000 
solution) are recommended in syphilitic iritis, and, if the inflamma- 
tion is not too acute, produce good results. Similar injections of 
physiological salt solution are equally efficacious, and preferable be- 
cause they cause less pain. 

In true syphilitic iritis mercury must be pushed to the point of 
tolerance, but it is not necessary to salivate the patient. Any form 
of mercury usually employed in secondary syphilis may be used — 
calomel, blue mass, or protiodide of mercury — but the most efficacious 
method is by inunction : this is preferable even to hypodermic medi- 
cation in the opinion of many authors. After the mercurial impres- 
sion has been made and the pupil is well dilated, potassium iodide, 
either alone or in combination with bichloride of mercury, is indicated. 
In plastic iritis, appearing six to eight months after the disappear- 
ance of the secondary symptoms, this latter treatment without the 
previous use of mercury has been recommended. Carmichael's plan, 
consisting in the administration of drachm doses of turpentine, in 
addition to which the potassium iodide may be given, receives the 
endorsement of some surgeons and is useful in serous iritis. 

Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, 
later, potassium iodide ; in the chronic types of the affection Zolli- 
coffer's mixture is an excellent remedy. Potassium iodide should be 
administered in gonorrheal iritis, and relief occasionally follows a 
pilocarpine sweat. In all forms of iritis the treatment of the consti- 
tutional disorder which has occasioned the local inflammation is neces- 
sary, and if the iritis becomes purulent surgical interference is usually 
required. In any variety of iritis the intense pain should be alle- 
viated with morphine or other anodyne sufficiently active to secure 
sleep. During the course of the disease saline laxatives may be 
administered, and after the subsidence and cessation of the specific 
treatment a course of iron tonics is an excellent routine practice. In 
chronic iritis, and in some forms of relapsing iritis, iridectomy is 
required in order to reopen the angle of the anterior chamber which 
has been closed by inflammatory exudates, and thus prevent secondary 
glaucoma. 

KERATITIS. 

Keratitis is the name applied to the various types of inflammation 
of the cornea. If this inflammation is associated with a breach in 



6S4 DISEASES. 

the continuity of the corneal surface, it is termed corneal ulcer, and 
four characteristic symptoms supply the indications for local treat- 
ment : (1) photophobia, or dread of light ; (2) blepharospasm, or spas- 
modic contraction of the orbicularis muscle; (3) congestion of the 
blood-vessels ; (4) pain ; while any existing dyscrasia or constitutional 
condition upon which the local disease may depend requires general 
medication. 

Interstitial Keratitis. 

Interstitial keratitis is that form of chronic diffuse inflammation 
of the cornea characterized by ciliary congestion and a ground-glass 
appearance of this membrane, most common between the ages of five 
and fifteen years, and in the vast majority of cases the result of 
inherited syphilis. No local measure is sufficient, antisyphilitic treat- 
ment being of paramount importance. During the height of the 
ciliary congestion warm antiseptic lotions and atropine are indicated, 
the latter especially to prevent the tendency to iritis. Severe pain 
may be alleviated by the use of a leech to the temple if the subject 
be of sufficient age to justify the employment of local bleeding. 
Exactly similar forms of keratitis are caused by rhachitis, scrofula, 
rheumatism, tuberculosis, and depressed nutrition. In addition to the 
local measures already described, the appropriate constitutional reme- 
dies are required, particularly iron, arsenic, codliver-oil, and the iodides. 
Suitable dietetic and general hygienic measures are important. 

Various other types of keratitis are described as the result of con- 
stitutional disturbances, such as gout (Hutchinson), malaria (Kipp, 
Van Milligen), or any condition of the system associated with great 
exhaustion, such as irregularities in the menstrual functions, certain 
forms of pulmonary disorders (true herpes of the cornea, Horner). 
The local management of these cases does not differ from that which 
has been described. The coexisting constitutional disturbances must 
be combated with suitable remedies. 

Phlyctenular Keratitis. 

Phlyctenular keratitis appears in the form of small, blister-like 
bodies, sometimes single, sometimes multiple, frequently situated 
directly at the corneo-scleral margin, which become yellow, break 
down, and leave an open ulcer (phlyctenular ulcer), to which runs a 
leash of injected blood-vessels. The disease is common in children, 
often follows in the wake of the exanthemata, and is so frequently 
associated with a strumous diathesis that it was formerly called stru- 
mous ophthalmia. In the majority of cases there is coexisting nasal 
disease, especially adenoid vegetations, which is responsible for the 
frequent relapses of the disorder, even if it does not cause it. 
Congestion may be relieved by frequent irrigation with a warm 
boric-acid solution. Pain and irritation call for the use of atropine 
drops (1 grains to the ounce [0.2 : 30.0]), which should be continued 
until tne ulcer is covered with regenerated epithelium, when the 
process of cicatrization may be hastened by the insertion daily into 
the conjunctival sac of a small quantity of yellow-oxide-of-mercury 



KERATITIS. 685 

salve or dusting it with finely powdered calomel, providing the patient 
is not taking at the same time any form of iodine. During the whole 
treatment the eyes should be protected by dark glasses and the sub- 
ject permitted to go out into the open air. All local treatment will 
prove unsatisfactory unless associated with strict hygiene, carefully 
regulated diet, and constitutional measures — tonics and alteratives — 
and the treatment of the naso-pharyngeal lesions. 

If the photophobia becomes distressing in spite of the other treat- 
ment, it has been suggested that this may be relieved by the use of 
cocaine, a practice that by no means commends itself in corneal ulcera- 
tion, in spite of the temporary relief from the local anaesthesia. Relief 
of this symptom in many instances follows the use of a douche of cold 
water on the closed eyelids, or by touching with blue-stone the ulcer- 
ated fissure at the external commissural angle, which is commonly an 
exciting cause of the spasmodic closure of the lids. 

Ulcerative Keratitis. 

Ulcerative keratitis, or ulcers of the cornea, may be primary in 
origin — that is, the disease begins in the cornea — and may be caused by 
phlyctenular disease, injury, abscess, depressed nutrition, etc. ; or may 
be secondary, and result as the sequel of severe inflammations of the 
conjunctiva: for example, purulent, diphtheritic, or granular conjuncti- 
vitis. There are numerous varieties of corneal ulcers, but three groups 
only will be mentioned : simple ulcers, which form a small, superficial 
gray lesion, and are not accompanied by much vascularity or dread of 
light ; purulent or deep ulcers, in which the open lesion is of yellowish 
color, and is surrounded by hazy cornea ; and infecting or sloughing 
ulcers (purulent keratitis), in which the ulcer assumes a serpiginous or 
creeping form, and there is usually a deposition of pus in the bottom 
of the anterior chamber (hypopyon-keratitis). Recent investigations 
indicate that typical serpiginous ulcer of the cornea with hypopyon is 
frequently caused by the Frankel-Weischelbaum capsulated diplococcus ; 
that ulcers not typically serpiginous may originate from a staphylococ- 
cus, streptococcus, or mixed infection ; and that a small percentage of 
sloughing keratitis is due to a schizomycetal infection — the aspergillus 
fumigatus. The various microorganisms come from the conjunctiva, 
the ciliary borders, the nares, and the lachrymal passage, and infect 
some slight abrasion on the corneal epithelium and thus start a dan- 
gerous form of suppurative keratitis. An abscess of the cornea may 
also occur as the result of an inoculation of the affected area with 
pathogenic microorganisms, typical forms sometimes appearing dur- 
ing scarlet fever, measles, typhoid and typhus fevers, and especially 
during the convalescent stage of smallpox. Simple corneal ulcers 
are treated in precisely the same manner as phlyctenular ulcers. 
The treatment of severe ulceration of the cornea, no matter what its 
etiology, may be summarized as follows : (1) Search should be made 
for the cause of the ulcer, including careful examination for the pres- 
ence of a foreign body, a misplaced cilium, conjunctival inflammation, 
lachrymonasal disease, affections of the rhinopharynx, carious teeth, 



686 ISEASES. 

and constitutional disorders of all types. (2) At frequent intervals 
moist heat should be applied by means of lint or flannel compresses dipped 
in water at a temperature of 120° F. (3) Unhealthy conjunctival dis- 
charge should be removed by frequent irrigations with mercuric 
chloride (1 : 8000), or a saturated solution of boric acid, or formal- 
dehyde (1 : 6000). (4) Sterile atropine drops (4 grains to the ounce) 
should be instilled with sufficient frequency to maintain mydriasis 
if there is any tendency to iritis. In the opinion of some 
surgeons, eserine (J to J grain to the fluidounce) is a useful 
drug in the treatment of peripheral ulcers with a tendency to per- 
forate the cornea, provided there is no iritis. Recent experiences 
of the writer indicate that the value of eserine in the treatment of 
corneal ulcers is problematical. (5) The eyes should be protected 
with smoked glasses ; but in severe cases and in the absence of puru- 
lent conjunctival discharge a dry antiseptic dressing, held in place by 
a light but firmly applied bandage, promotes healing and prevents per- 
foration. It may be worn until the floor of the ulcer is covered with 
epithelium, and removed whenever the applications are required. A 
little iodoform may be dusted upon the surface of the ulcer before the 
bandage is applied, or the ulcer may be covered with an iodoform 
wafer. (6) If the ulcer shows a tendency to spread rapidly, it should 
be curetted and immediately afterward gently touched with a probe 
which has been dipped in pure carbolic acid, or with a wisp of 
cotton which has been dipped in a solution of nitrate of silver (10 
grains to the ounce), tincture of iodine, or formaldehyde (1 : 60). Of 
these remedies, nitrate of silver and tincture of iodine yield the 
best results. (7) If the ulcer continues to spread, the actual cautery 
may be used, the glowing point of the cautery-needle being applied to 
every portion of the ulcer, the area of which is outlined by means of 
fluorescine (2.5 per cent, solution), which will color green any portion 
of the cornea deprived of its epithelium, and therefore furnish a reliable 
guide to the extent of the destructive process. Before these severe 
applications are made the cornea should be rendered insensitive by a 
few drops of a holocain solution, and the ulcer itself painted with a 
cotton wisp dipped in holocain. Indeed, there is much evidence to 
show that the application alone of this drug has a distinct curative 
influence on corneal ulcers, in this respect differing very distinctly from 
cocaine, which rather retards the cicatrizing process. Subconjunctival 
injections of mercuric chloride have also been highly praised in the 
treatment of corneal ulcers, but have not yielded good results in the 
authors practice. If an abscess forms in the cornea, the pus should 
be evacuated by an incision; and hypopyon, or pus in the anterior 
chamber may be drained by an operation after the manner of Saemisch 
— that is, by division of the corneal layers — or by a simple paracentesis 
of the cornea. 

Sequelae of Corneal Ulceration. 

After healing of a corneal ulcer the cicatrix consists of a more or 
less dense white spot in the cornea (macula), [f these scars are thick 
and white, they are irremediable by local medication and require sur- 



LACHRYMAL ABSCESS— LARYNGITIS, ACUTE. 687 

gical interference for optical relief. If, however, they are diffuse, 
much good will follow systematic massage of the cornea, aided by 
the introduction of a small particle of yellow-oxide-of-mercury salve. 
The massage is performed as follows : A piece of the salve the size 
of a split pea is introduced beneath the upper lid ; upon the closed 
lid a finger is placed, and regular motions made through the lid over 
the surface of the cornea — namely, vertical, lateral, and radial motions, 
the stance being completed by circular movements. The whole should 
last from one to three minutes. Alleman claims excellent results in 
dissipating corneal opacities by the use of electricity by connecting a 
suitably prepared electrode with a battery, the cathode being placed 
directly on the previously anaesthetized cornea and the anode on the 
cheek. Subconjunctival injections of physiological salt solution, 
placed near the corneal margin, have some power in causing absorp- 
tion of corneal nebula. 

LACHRYMAL ABSCESS. 

Lachrymal abscess results from suppuration in a chronically dis- 
tended lachrymal sac, owing to the presence of obstruction in the 
nasal duct, and exists as a swelling under the skin at the inner can- 
thus, pressure upon the surface causing an escape of pus through the 
canaliculi. The treatment is practically confined to surgical inter- 
ference—that is, division of the canaliculi and washing out the dis- 
tended sac with antiseptic fluids, and restoring the patulency of the 
nasal duct by the use of probes as soon as the inflammatory symptoms 
have subsided, or, if the skin over the seat of the abscess is thinned 
and rupture is threatened, by free puncture downward and outward. 
In purulent discharge from the lachrymo-nasal duct solutions of formal- 
dehyde (1 : 6000), nitrate of silver (1 : 500), or protargol (2 to 5 per 
100), injected through the passage, favorably modify the unhealthy 
secretion. Much comfort will ensue from the use of hot compresses 
over the inflamed area. These may be made in the ordinary way, or 
are still more efficacious if composed of a lead lotion, the ordinary lead- 
water and laudanum answering the purpose very well. 

LARYNGITIS (ACUTE). 

The treatment of acute laryngitis is identical in many respects 
with that directed against acute inflammatory processes elsewhere. It 
may be divided into local, external, and internal methods. The con- 
dition of the larynx when acutely inflamed is that of intense hyper- 
emia and irritation, and the object of the physician must be to allay 
this irritability. This is best accomplished by the use of compound 
tincture of benzoin, which is placed in boiling hot water (1 ounce to the 
pint [30.0 : 500 cc.]), and the steam inhaled as it rises from a pitcher or 
as it passes out of the nozzle of a deep coffee-pot. A better apparatus, 
if it can be obtained, is a can or wide-mouthed bottle arranged with 
one long and one short tube like a Wolff bottle, the air being drawn 
into the larynx through the short tube. This inhalation should be 
resorted to six or eight times a day, but the patient must not go out of 
doors or into a cold room, as the steam relaxes the parts involved and 



688 DISEASES. 

renders them more susceptible to cold. Sometimes advantage is gained 
by adding to this inhalation 1 grain (0.05) of menthol. If the patient 
is unable to remain in an equable temperature, then the steam-inhaler 
should be supplanted by the use by the physician of a nebulizer, and 
in this apparatus should be placed a mixture as follows : 

R .—Menthol gr. iij (0.15). 

Albolene fg (30.0).-M. 

S. — Use as a spray. 

The patient is directed to gently inhale this vapor, which because of its 
lightness readily passes deeply into the air-passages, and has the effect of 
soothing rather than irritating them as does the spray from an atomizer. 
Rarely in the very acute stages of laryngitis should the physician 
employ a watery spray to wash the laryngeal mucous membrane, as it 
is apt to increase the irritation. If any aqueous spray is used, as may 
be necessary when the irritation has resulted from the inhalation of dust, 
it may be made up as follows : 

R.— Sodii chlorid gr. xv (1.0). 

Acid, boric gr. x (0.65). 

Sodii borat gr. x (0.65). 

Aquae rosse fgiij (90.0).— M. 

S. — Use as a spray. 

The external treatment, if the inflammation is exceedingly severe 
and the patient can be confined to bed, is a mustard plaster or hot 
application over the larynx, care being taken that the volatile mus- 
tard does not render the inhaled air irritating to the larynx. A mus- 
tard foot-bath and a warm drink on going to bed are useful. 

The internal treatment should consist in opening the bowels with 
calomel and a saline purgative if constipation is present, and in the 
adminstration of full doses of aconite and bromide of sodium or potas- 
sium, as follows : 

R. — Tine, aconiti ^xij vel xxiv (1.0-1.6). 

Sodii bromidi sjij (8.0). 

Syr. lactucarii (Aubergier) .... f§j (30.0). 

Aquae q. s. ad f^iij (90.0).— M. 

S. — Dessertspoonful (8.0) every hour for six or eight doses. 

This prescription may in many cases be continued until convalescence, 
as it stops cough, quiets the inflamed area, and allays arterial excite- 
ment. Often it is best to omit the aconite after the first few doses. 
In other cases good results follow the use of 2 or 3 minims of dilute 
nitric acid in water every half hour or hour for 6 doses. This is use- 
ful in the early stages only. By the second day the patient should be 
directed to make a heavy application of tincture of iodine over the 
trachea and episternal notch, as high as is possible without the stain 
showing above tin; collar. In children and in some adults this is well 
substituted by oil of amber and sweet oil in the proportion of 1 to 3 
parts rubbed on the skin. 

For the stiffness following the inflammation preparations of coca 
are very useful given internally, and tonics to the general system 
are needed. 



LEUCOBBHCEA. 689 

Abrams asserts that freezing the skin over the insertion of the 
internal laryngeal nerve, near the thyrohyoid space, where it enters 
the larynx, is a very useful curative measure. This should be re- 
peated several times if need be. 

LEUCORRHGE3A. 

This is a condition — vulgarly known as the " whites " — consisting 
in a hypersecretion from those glands which pour out their contents 
into the vagina or the cervical canal of the uterus, or even into the 
cavity of this organ. 

It is a state dependent upon many causes for its existence, the 
chief of which is a condition of the system when it is "run down" 
from any cause, with perverted functions of the glands or their sur- 
roundings. The character of the discharge varies with almost every 
case. In some instances it is thick and tenacious, in others so liquid 
as to trickle down the limbs and greatly soil the clothing. In most 
of the latter cases catarrh of the Fallopian tubes or ovarian irri- 
tation and tenderness will be present. Where the secretion is very 
thick and tenacious it generally arises from the cervical canal, while 
that from disorder of the vaginal wall alone, independent of other 
morbid conditions, may be either thick or thin. 

The treatment of these forms of leucorrhoea may be divided into 
two parts — one, that directed to the remedying of the morbid process 
through the use of drugs by the mouth ; the other, by their employ- 
ment locally. 

It is needless to state that in that form dependent upon excessive 
lactation or other exhausting manner of life tonics of an active cha- 
racter are needed. As a general rule, anaemia will be present, and 
the following pill will be found of service : 

R. — Acid, arsenosi gr. \ (0.016). 

Ferri redacti gr. v (0.25). 

Quininae sulph §j (1.3).— M. 

Ft. in pil. No. xx. 
S. — One pill three times a day, after meals, for an adult. 

Or, 

R. — Tr. cinchonse comp f^ij (60.0). 

Tr. gentian, comp q. s. ad f^iv (120.0). — M. 

S. — Dessertspoonful (8.0) three times a day, after meals. 1 

Sometimes small doses of the sulphate of iron are better for this 
purpose, owing to its astringent properties, but when any prepara- 
tions of iron are used care must be taken that the bowels are kept 
active and that the stomach is not disordered. Associated with the 
use of these internal remedies should be a moderate amount of exer- 
cise and the avoidance of late hours and rich foods. 

The local applications which are of value in these states consist in 
counter-irritation and vaginal injections or painting the mucous mem- 

1 In the first prescription the small amount of iron given will probably be noted, 
but this is done advisedly, as iron does as much good to the blood in small as in large 
amounts under most circumstances. (See Iron.) 

44 



090 DISEASES. 

brane of the parts from which the discharge comes with proper fluids. 
In the leucorrhoea dependent upon irritation of the ovaries with 
catarrh of the Fallopian tubes the use of small blisters formed by 
the employment of cantharidal collodion or a cantharidal plaster over 
the groin on either side is often accompanied by good results. At 
the same time the vaginal surfaces surrounding the cervix uteri may 
be painted with a mixture of iodine, carbolic acid, and chloral, such 
as is used by Dr. Goodell, as follows : 

R .— lodi resublimat giv (16.0). 

ch C io ri al rbol,crystal } • • • ^3(30.0). 

Kub the iodine and chloral in a glass mortar into a powder and add the 
carbolic acid. 
S. — Formula. To be used by the physician only. 

The following pill may also be employed : 

R. — Hydrarg. chlor. corros gr. \ (0.03). 

Ft. in pil. No. xx. 
S. — One pill three times a day, after meals or a tablet triturate may be used instead of 
a pill. 

The remaining treatment of watery leucorrhoea consists in the use 
of astringent injections. A very cheap astringent injection is made 
by adding 1 ounce (30.0) of powdered white-oak bark to each pint 
(500 cc.) of water, or tannic acid and glycerin in the proportion of 1 
ounce to 2 quarts (30.0 : 2 litres) of warm Water. Ringer recom- 
mends the following : 

R. — Sodii bicarbonatis 3j (4.0). 

Tincturae belladonnas f^ij (8.0). 

Aquae Oj (500 cc.).— M. 

S. — Use as a vaginal wash. 

Where the discharge is foetid a solution of permanganate of potas- 
sium should be used as an injection in the strength of J drachm to 1 
pint (2.0 : 500 cc.) of water. In purulent vaginitis, specific or other- 
wise, the following injection is serviceable : 

R.— Creolin f^ss vel f^ij (2.0-8.0). 

Ext. hydrast. canaden. fl f^ijss (10.0). 

Aquae f^viij (240.0).— M. 

S. — Add 2 tablespoonfuls to a pint (30.0: 500 cc.) of hot water, shake thoroughly, and 
us(," as an injection. 

Sometimes a tampon thoroughly saturated with a powder of iodo- 
form and tannic acid, equal parts, and packed around a discharging 
uterine cervix, is of service. 

When using vaginal injections in females it is important to remem- 
ber thai they should be in large quantities. Nothing is more antago- 
nistic to true asepsis than the usual manner in which these applica- 
tions are made. Generally a pint of the solution is placed in a basin 
over which the woman squats, and by means of a syringe forces the 
Liquid info the vagina as fast as it runs out, thereby filling the syringe 
joints with the dissolved secretions, and returning to the vagina as 
Boon as they flow away the impurities which have left it. The only 



LID ABSCESSES— MANIA, ACUTE. 691 

proper way to give such an injection is to have the solution in one 
basin, to the extent of 1 gallon (4 litres), while the patient squats over 
a second basin, into which the impure liquid may run. 

A very useful astringent injection may be made by ordering 

R.— Zinc, sulphat gj (4.0). 

Alumin. sulph ^i (4.0). 

Glycerini i. . 13VJ (180.0).— M. 

S. — A tablespoonful (16.0) to each quart (1 litre) of water. 

LID ABSCESSES. 

Lid abscesses are seen more frequently in children than adults, as 
the result of injury, the sequel of acute illness (epidemic influenza, 
pulmonary catarrhs, fever, etc.), or from local infection ; under the 
latter circumstance they may assume a gangrenous type. The treat- 
ment is that for any form of abscess — poultices, preferably in the form 
of hot compresses, early incisions, antiseptic solutions, and tonics. 

LUMBAGO. 

This is a form of myalgia or muscular rheumatism of the muscles 
of the loins and small of the back, and is frequently the result of 
lifting heavy weights or it results from other strains. In many cases 
acupuncture is very useful, particularly if the trouble is bilateral. (See 
Part III.) Sometimes after the employment of this measure the patient 
can straighten the back at once and retain that position. In other 
instances antipyrin or acetanilid, in 5- to 10-grain (0.35-0.65) doses 
of the former and 2- to 4-grain (0.1-0.2) doses of the latter, are of 
service, and iodide of potassium and salicylic acid are not to be for- 
gotten if the condition of the patient does not rapidly improve. 
Phenacetin and salol are also useful, combined or alone. A large hot 
poultice applied to the back is often efficacious in obstinate cases. 
Sometimes the use of a hot foot-bath and a Dover's powder on going to 
bed will produce a cure, and ironing the back with an ordinary hot 
laundry iron at a proper heat, a piece of newspaper or cloth being 
placed over the skin under the iron, is very efficient. Counter-irrita- 
tion in the shape of a blister, a mustard plaster, or capsicum draft will 
often give relief. 

Where these measures fail the reverse treatment may be tried, such 
as an ice-bag placed over the loins or an ether spray turned on the 
part until the skin is greatly blanched. 

MALARIAL FEVER. 

(See Intermittent and Remittent Fevers and Pernicious Mala- 
rial Fever.) 

MANIA (ACUTE). 

Space is wanting to consider the thorough and complete treatment 
of mania as it comes to the neurologist. All that can be done here is 



692 DISEASES. 

to denote temporary measures suitable for cases which are brief in 
their course. 

In those cases which occur after confinement and are not supposed 
to be based upon permanent trouble, cimicifuga racemosa is said to 
be very useful in the dose of 20 to 30 minims (1.3-2.0) of the fluid 
extract three times a day, while for the rapid quieting of the patient 
Ave may use hyoscine hydrobromate in the dose of y^-g- grain (0.0006). 
In other instances, if the kidneys and heart are healthy, full doses 
of chloral may be used, and if an active preparation of cannabis indica 
can be had. at least 1 grain (0.05) of the solid extract or J to 1 drachm 
(2.0-4.0) of the tincture should be employed. Cannabis indica will be 
found particularly serviceable if 60 grains (4.0) of one of the bromides 
can be combined with it. 

Where a patient suffering from mania is so violent that nothing 
can be done with him. he should be held, and an emetic dose of ^ 
grain (0.005) of apomorphinebe given hypodermically to produce vom- 
iting and so relax the muscular system, or he may be tied or anesthet- 
ized sufficiently to enable the physician to administer proper remedies. 
Sometimes full doses of morphine are needful, and in others a cold 
douche to the head while the body is in a tub of hot water is of service. 

MELANCHOLIA. 

This is not the place for the discussion of melancholia of so severe 
a form as to amount to insanity, since the treatment of this latter state 
is very various and largely depends upon the skill of trained physi- 
cians who are alienists. 

There is one form of melancholia, however, which may often be 
rapidly relieved by a simple measure. It is that dependent upon the 
condition of the system in which oxaluria is present. Whenever an 
individual complains of melancholia the urine should be examined, 
and if any oxalate crystals are found, undiluted, fresh nitromuriatic 
acid should be given in the dose of 5 minims (0.3) after each meal 
in a half-tumblerful or more of water. In order to guard against 
errors in diagnosis it is well to remember that pears, tomatoes, rhu- 
barb, and cabbage all cause oxalates to appear in the urine for a short 
period after their ingestion. 

MENINGITIS (ACUTE). 

Meningitis is to be treated as is any other form of acute inflamma- 
tion occurring in a sthenic or dynamic individual, and particularly 
doc- it- treatment correspond to that of the other inflammations of 
large serous membranes, such as peritonitis or pleurisy. 

In the early Btages, if the pulse is full and bounding, the patient 
should receive sufficiently large doses of aconite or veratrum viride to 
strongly impress the circulatory system. These drugs have the power 
of producing such dilatation of the blood-paths throughout the body 
that the congested or inflamed area is relieved of its excess of blood, 
because, the pressure being low elsewhere, the blood obeys the law 



MIGRAINE. 693 

that liquids always try to escape from pressure, and so leaves the 
meninges of the brain for the vessels of the limbs and trunk. A 
good-sized blister should always be placed at the nape of the neck as 
a counter-irritant to prevent effusion. 

The proper dose of veratrum viride in the form of the tincture is 
3 minims (0.15) every hour until the skin becomes moist or nausea is 
developed. 1 The tincture of aconite is also useful in full dose. If 
great arterial excitement is present, venesection may be practised, 
(see Bleeding), but veratrum viride and aconite are better remedies if 
they are at hand. Associated with these two drugs we should employ 
mercury and opium, the first for its antiphlogistic influence, the second 
for its power in allaying irritation. J grain (0.016) of powdered 
opium and ^ grain (0.03) of calomel may be given every hour until the 
full effect of the opium or mercury is manifested. In some instances 
the deodorized tincture of opium (Tinetura opii deodorati) is better 
than the crude drug, in the dose of 2 to 5 minims (0.1-0.25) every 
one or two hours. Sometimes belladonna is of great service, and this 
is particularly the case where the drugs already named are contrain- 
dicated because of a condition of weakness oi* asthenia. 

During the first acute stage an ice-bag should be applied to the 
head, both for its local influence and its antipyretic effect, and leeches 
may be put at the nape of the neck with advantage. As the disease 
advances and the nervous disorders of the affection become marked, 
nervous sedatives are required to allay the twitchings, muscular 
spasms, or convulsions, and for this purpose no drugs are to be com- 
pared to chloral and the bromides. The doses to be used vary with 
the violence of the symptoms, but it may be stated that the chloral 
should rarely, if ever, be used in doses above 10 grains (0.65), and 
the bromides given in the dose of from 5 to 40 grains (0.3-2.65). 
If coma comes on, a large blister should be applied to the nape of 
the neck. 

Quinine has been recommended in meningitis, but it is absolutely 
contraindicated, as it predisposes to meningeal congestion. It may be 
employed only in convalescence, and then used most carefully. 

The treatment of the second stage of meningitis must be neces- 
sarily supportive, owing to the reaction consequent upon great ner- 
vous and arterial excitement. Under these circumstances the use of 
opium is still indicated, because it allays nervous unrest and supports 
the system, partly by conserving the tissues and partly by inhibiting 
the waste of nervous force apt to occur at this time. Alcohol should 
be given with the food if weakness is present, and a very simple or 
milk diet insisted upon. 



MIGRAINE. 
(See Neuralgia.) 

1 It is to be remembered that veratrum viride often causes nausea, and even vomit- 
ing, in susceptible persons, and in consequence it should be carefully given in menin- 
gitis, lest if vomiting come on the disease be made worse. 



694 DISEASES. 

MUSCLE VOLITANTES. 

Muscse volitantes is the name applied to the dark specks which 
patients frequently see floating across their fields of vision, especially 
if the eyes are directed toward a bright sky or a white page. Usually 
they indicate no disease of the vitreous humor, and the ophthalmo- 
scope fails to detect abnormal changes. They are attributed to tor- 
pidity of the liver by the laity. Muscae volitantes may indicate eye- 
strain, and if the refraction is abnormal this should be corrected ; a 
mild course of alteratives is often a useful adjuvant. 



MYALGIA. 

Soreness of the muscles either on pressure or on movement may be 
dependent upon a number of causes, such as strains, bruises, toxaemia, 
or inflammation due to cold. Here, as in many other states, the treat- 
ment should be divided into the external and the internal methods. 
Of the internal remedies, the best are the salicylates or the iodide 
of potassium if rheumatism be at the base of the trouble. On the 
other hand, if a bruise or cold be the cause, the chloride of ammonium 
will be of service in 10- or 20-grain (0.65-1.3) doses given in a solu- 
tion with fluid extract of liquorice. (For prescription see Bronchitis.) 
Other remedies which may be tried with a good chance of success are 
full doses of a good fluid extract of cimicifuga (20 minims to 1 drachm 
[1.3-4.0]) or the citrate or acetate of potassium in 20-grain (1.3) 
doses. 

The local medications are numerous, but only a few can be con- 
sidered as worthy of routine employment. The chief one is iodine, in 
the form of the pure ointment or the ointment diluted one-half with 
lard if the skin is easily irritated. Another method is to employ a 
liniment, well rubbed into the skin, made up as follows : 

R.— Tr. belladonna f^j (4.0). 

Tr. aconiti f^ij (8.0). 

Tr. opii . . . f^ij (8.0). 

Liniment, saponis q. s. adf^vj (180.0). — M. 

S. — Poison. To be used externally and only as a liniment. 

Sometimes chloroform liniment is singularly successful, and poul- 
ticea applied as hot as can be borne and covered by oil-silk and cotton 
to retain the heat are often of great value. Massage or good rubbing 
is also a sine qud non for the successful treatment of this state. 



NASAL CATARRH (ATROPHIC). 

In atrophic nasal catarrh the nostrils are roomy and the mucous 
membrane red and shiny. The formation of connective tissue has, 
to a greal degree, obliterated the delicate serous glands, and the dis- 
charge of mucus, no Longer diluted, forms inspissated crusts, which 
adhere to the mucous membrane of the septum and turbinated 

hole 



NASAL CATARRH, ATROPHIC. 695 

Areas of ulcerated or abraded membrane are disclosed upon 
removal of these adherent crusts. 

The turbinated bones are gradually absorbed and the secreting 
surface thereby much reduced. Sometimes the wasting is so great 
that the posterior wall of the pharynx is clearly visible through the 
anterior nares. The inspissated secretion may make a cast of the nos- 
tril, and as fresh layers form underneath the oldest part is raised until 
the whole interior of the nostril becomes a mass of decomposition, giving 
rise to an overpowering stench. This form of catarrh causes loss of 
the sense of smell, and the odor is not recognized by the patient him- 
self. Ulceration or caries of the bony structure produces an odor 
even worse than the so-called ozcena. The pharynx suffers from the 
general wasting, and presents a dry, varnished appearance called 
pharyngitis sicca, which is rather a symptom of nasal atrophy than 
a separate disease of the pharynx. 

The indications are the removal of all accumulations in the nose 
and naso-pharynx and the healing of abraded or ulcerated surfaces. 
The early removal of dead bone is imperative, and what secreting 
surface remains must be stimulated as far as possible, to compensate, 
in a measure, for the glands that are hopelessly destroyed. In other 
words, our efforts are directed toward producing a compensatory hyper- 
trophy of the glandular tissue that remains. Therefore Avith the use 
of antisepsis we combine alteratives and local stimulation. 

The nose should be thoroughly cleansed with an alkaline wash — 
Dobell's solution — warmed to increase its solvent power. To relieve 
the odor increase the amount of carbolic acid or substitute for it 
eucalyptol and thymol in the wash. Euthymol contains both of these, 
and may be added to the wash. Its own pungent odor masks some- 
what the offensive odor. Permanganate of potassium may be used in 
weak solutions, but it is painful except when sensation is entirely lost. 
Peroxide of hydrogen is valuable used in an atomizer in the strength 
of 1 part to 10 or 1 to 20. After this has softened the crusts they 
should be dislodged by the further use of a warm alkaline spray, and 
after the cleansing is complete ichthyol, pure or diluted one-half with 
water or albolene, is applied by means of an applicator. Often a much 
weaker solution of ichthyol will do equally well. The patient may be 
given a salve of: 

R.— Ichthvol gr. xl (2.6). 

Menthol gr. v (0.3). 

Albolene gj (30.0).— M. 

A piece of this is to be inserted into the nose, after using a douche, 
each night. 

The solutions are best applied by means of an atomizer, or post- 
nasal syringe in the hands of the physician, or by snuffing from the 
hand or cup. 

The odor, if due to decomposition, is much decreased as soon as 
the passages are clear. The discharge must never be allowed to 
reaccumulate or much time will be lost. 

Ulcerations require local stimulation by a strong solution of nitrate 



696 DISEASES. 

of silver or a superficial application of the flat surface of the galvano- 
cautery heated to a dull redness. Necrosed bone should be removed, 
and it is often found detached in the nostril. 

Local stimulants should be judiciously combined with alteratives. 
Powders of nitrate of silver in starch, varying in strength from 1 to 
10 grains to 2J drachms (0.65-10.0) of the latter, may be blown 
into the nostrils by means of an insufflator. Cover gently the whole 
surface with a thin layer, and use it only of sufficient strength to be 
slightly felt. Nitrate of silver, in solution, 1 to 10 grains to 1 fluid- 
ounce (0.05-0.65:30.0) gives better results at other times when 
applied to the mucous membrane. The physician must avoid over- 
stimulating, and so exhausting, the glands which it is wished to 
strengthen. The use of alteratives may alternate with the silver salt 
and iodide of potassium, and this may be done by using solutions 
of iodine and glycerin, as recommended for hypertrophic nasal catarrh. 
Internally, ^ve may employ iodide of potassium, to increase nasal 
secretions, and mucous-membrane stimulants and tonics. Attention 
should also be paid to the activity of the skin. 



NASAL CATARRH (CHRONIC). 

Chronic nasal catarrh is essentially a disease of civilization, which 
may occur at any period of life, but more commonly develops from 
youth to early adult life. 

Although very prevalent among the upper classes, it is in the 
lower ranks that it most frequently reaches its later stages and its 
worst forms. This does not result from lack of opportunity for treat- 
ment, but from the ignorance or indifference which this class show to 
diseases while there is no suffering and no interference with business. 

Hypertrophic nasal catarrh commonly has its origin in a neglected 
cold in the head or in a series of colds occurring in rapid succession, 
keeping the nose in a congested state until the erectile tissue covering 
the turbinated bones loses in a measure its power of contracting, and, 
decreasing the calibre of the nostrils, becomes a source of permanent 
obstruction to breathing. 

As the disease increases there is increased susceptibility to cold. 
Slight exposure produces a stuffy feeling in the nose. The nostrils 
may become completely occluded ; usually, however, only one side 
at a time is obstructed at first, the obstruction showing a tendency 
to change sides. This change is most noticeable in turning in bed, 
the lower side usually stopping, and on changing the position the 
obstruction is reversed, the clearing being accompanied by a crack- 
ling sensation. A slight tickling cough and tendency to clear the 
tlno.it in the mornings may result from irritation of the pharynx or 
larynx. 

The first indications for treatment are the reduction of inflamma- 
tion and restoration of the breathing-space. 

Ai the chief function of the nose is respiratory, the rc-establish- 
mcn! of free aasal respiration, combined with the liberal use of anti- 



NEPHRITIS, ACUTE. 697 

septic washes, will lessen the inflammation and irritation and produce 
a healthier state of the secretions. 

The writer places cleanliness at the head of the list of remedial 
measures. The alkaline wash recommended on page 581, sprayed 
into the nose by a hand atomizer or gently snuffed from the palm of 
the hand or from a small cup, gives good results. The hand warms 
the solution slightly, but when snuffed from a cup the solution should 
be artificially warmed. This wash may be used two or more times 
a day. 

The nasal douche should never be used where there is nasal ob- 
struction, on account of the risk of forcing the solution into the 
Eustachian tube and causing catarrh of the middle ear. 

In addition to the antiseptic wash where the mucous membrane is 
congested and irritable, the treatment recommended for coryza may 
be instituted for a few days with good results. A solution composed 
of equal parts of distilled extract of hamamelis and water or a dilute 
solution of hydrastis may be sprayed into the nose during the acute 
stage. 

A little later a spray of ferric alum, 5 grains to the ounce (0.3 : 
30.0), may be applied carefully in an atomizer by the physician. 

It is not advisable to use alum in any considerable strength in the 
nose, as its continued use is liable to impair the sense of smell. 

The alterative and absorbent action of iodine makes it a valuable 
remedy for local application in chronic nasal catarrh. Combine it 
with glycerin in the strength of 6 or 8 grains to the ounce (0.35 : 
30.0), with enough potassium iodide to make a solution. Apply this 
by means of a piece of absorbent cotton on the end of an applicator, 
along the floor of the nose, until it reaches the pharynx. It is need- 
less to say that such an application as this should be made with the 
utmost gentleness. The cotton should project beyond the probe, and 
care should be taken to avoid bruising the tissues. 

After the irritation has subsided, as shown by the disappearance 
of the livid color and lessened sensibility, any remaining hypertro- 
phied tissue should be removed by a snare or the galvano-cautery. 

NEPHRITIS (ACUTE). 

The treatment of acute nephritis requires intelligent care. The 
pain in the loins, and, perhaps, the bloody urine which is scanty and 
high-colored, febrile disturbance, and the history of exposure or other 
exciting cause, all form a clinical history typical in its major points. 
Here, as elsewhere, for the reduction of inflammation circulatory depress- 
ants are to be resorted to, and aconite is generally most service- 
able. The patient should be kept quietly in bed and supplied with 
a milk diet, cups or leeches being used over the loins if the urine is 
scanty. Blisters are not advisable, as the irritant substances pro- 
ducing them may be absorbed and cause increased renal irritation. 
The restlessness will generally be quieted by the aconite ; but if this 
fails, resort must be had to bromides or small doses of opium, which 
must be given cautiously, as these drugs are not readily eliminated 



698 DISEASES. 

when the kidneys are diseased. Cannabis indica is thought to be of 
great service if bloody urine is present, but chloral is generally too 
irritating to the kidney to justify its employment. The appearance 
of large amounts of biood in the urine at about the fifth day of the 
illness is an indication, according to Sydney Ringer, for the use of 
drop doses of tincture of cantharides, given every few hours. Should 
the urine be scanty and of high specific gravity, and constipation be 
present, some calomel, or a purgative dose (-J- an ounce [16.0]) of sul- 
phate of magnesium should be used to aid in the elimination of 
impurities by the bowel. Warm mucilaginous drinks, as flaxseed 
tea, are of service, and the use of the citrate of potassium and the 
sweet spirit of nitre with copious draughts of pure water should be 
resorted to to increase urinary flow and promote the action of the skin. 
If dropsy or symptoms of uraemia (see Uraemia, Part IV.) come on, 
they may be relieved by the use of hydragogue purges, such as elate- 
rium, which is particularly useful in that it is supposed to aid in the 
elimination of the urea by the bowel. If vomiting is present, elate- 
riuin ou^ht not to be used, as it irritates the stomach. Jaborandi or 
pilocarpine may be used to sweat the patient at this time or in the 
earlier stages with advantage; -J grain (0.008) of the hydrochlorate 
should be given hypodermically, and repeated in fifteen minutes if no 
sweat appears ; but it should never be forgotten that when the heart 
is feeble or the patient very susceptible pilocarpine may produce 
serious collapse. This can sometimes be guarded against by the simul- 
taneous use of strychnine in - 2 -^ grain (0.003) doses. Hot-air baths 
are often useful to provoke sweat and are much safer than pilocarpine. 
(See Heat, Part III.) 

The treatment of the later stages consists in the use of stimulants 
to the kidneys to arouse them from the atony consequent upon the 
excitement of inflammation. To this end digitalis and squill, or digi- 
talis and calomel, or caffeine citrate, may be used in small amounts, 
gradually increased and followed by the compound spirit of juniper or 
gin as the case progresses. If the renal structure is persistently atonic, 
V to 1 minim (0.01-0.05) of the tincture of cantharides at each dose 
may be used, and, as anaemia is often a prominent symptom, tincture 
of the chloride of iron, which is both a diuretic and a tonic, should be 
resorted to. If renal hemorrhage is excessive, gallic acid and ergot 
are indicated to control the bleeding. A milk diet should be rigidly 
enforced. 

NEPHRITIS (CHRONIC). 

The treatment of chronic nephritis is a very different matter, so 
far as prognosis is concerned, from that of the acute form. It is 
almost, if Dot quite, impossible to cure the condition present, and we 
can only improve the state of the kidneys and other organs by care 
and the use of proper drugs. As Tyson has aptly put it, we must 
try to arresl the development of the renal lesions and improve the 
general health, treal the symptoms which are not dependent upon the 
nephritis, excepl indirectly, and, last, treat those signs which are due 
to the nephritis itself. To arrest the disease all alcoholic drinks 



NEPHRITIS, CHRONIC. 699 

should be avoided as far as possible, and business cares and worries 
be cast aside. Great care should be taken to avoid cold, and a warm 
climate is generally to be recommended to the patient, since sudden 
changes of temperature tend to produce congestion of the kidneys by 
the chilling of the skin. 

The diet and drink are important considerations, and should con- 
sist largely of milk. Many physicians direct that skimmed milk be 
used. The author believes that this advice is not wise, as it deprives 
the patient of the nutritive fats, which he needs and which are not 
contraindicated, whereas the proteids of skimmed milk, while the 
best form of albuminoid food we can give, are not advantageous, but 
have to be used to maintain nutrition. If the cream in the milk dis- 
agrees with the patient, it may be removed or diluted by effervescent 
water. 

The treatment suggested so far is applicable to all forms of chronic 
nephritis, but there are symptoms and complications of both the inter- 
stitial and parenchymatous forms of the disease which require special 
treatment. If the urine be scanty in the parenchymatous form, and the 
heart is feeble, digitalis and caffeine are useful to improve the renal cir- 
culation and act directly on the kidney. In other cases we may pre- 
scribe the w ell-known pill of digitalis, squill, and calomel. These drugs 
not only increase urinary flow, but also decrease albuminuria in many 
cases. In still other instances we may give the acetate and bitartrate 
of potassium as diuretics, which are particularly valuable if combined 
w T ith digitalis in those cases of albuminuria dependent upon failure 
of the heart muscle ; nor should the bichloride and protiodide of 
mercury be forgotten, as they are very valuable indeed for their 
alterative influence. These remedies are also of value to relieve the 
dropsy, and one of the most efficacious forms of treatment is a com- 
bination of the bitartrate of potassium and juniper-berries, so that 1 
ounce (30.0) of the former is dissolved in 1 pint (500 cc.) of an infu- 
sion (1 ounce (30.0) to the pint) of the latter and taken in twenty- 
four hours. A most valuable aid in decreasing the albuminuria is 
the use of 2 minims of tincture of cantharides in water three times 
a day, particularly if the kidney seems torpid and is secreting too 
little urine. If dropsy develops (see Dropsy), hydragogue purges are 
useful, such as jalap and elaterium, and hot baths, Turkish or Russian, 
are to be given, not only to relieve the dropsy, but to $o hypertrophy 
the excretory glands of the skin that they will be able through greater 
activity to relieve the kidneys. (See Heat.) 

Very great benefit can often be obtained by the use of nitro- 
glycerine given in ascending doses beginning with y^- grain (0.0006) 
three times a day. This decreases the albuminuria, if it is present, 
lowers arterial tension and benefits the heart. Copious draughts of 
pure water should be given, if the urine be scanty, to flush the kidneys 
if possible and aid sweating, although copious urination may in many 
cases be present and troublesome. Another drug of value in those 
cases of chronic contracted kidney which have their origin in gout or 
syphilis, is iodine in the form of iodide of sodium. This may be given 
in 10-grain (0.65) doses three times a day with great advantage to old 



700 DISEASES. 

persons with well-advanced atheromatous changes. The treatment of 
uraemia, should it be mild or severe, is important, and the reader is 
referred to the article on that subject (see Uraemia). The various 
forms of hot baths should also be employed to aid the skin in elimi- 
nating poisons and so relieve the kidney. 

The anaemia in parenchymatous nephritis is to be combated by the 
use of the* tincture of the chloride of iron, or Basham's Mixture (see 
Iron), and oxygen inhalations. In the interstitial form of the disease 
iron must be used with caution, or not at all, as it is apt to produce 
headache and perhaps conduces to the development of uraemia. It is 
in this form of renal disease that nitroglycerine does the most good by 
lowering arterial tension and so saving the heart from excessive labor. 
In cases in which the kidney is suspected of being inadequate by 
reason of disease, we may give 1 grain (0.05) of methylene blue in 
water, hypodermically. If the color appears in the urine in an hour, 
the kidney is probably fairly active. 



NEURALGIA. 

Like headache, neuralgia gives rise to most of the suffering expe- 
rienced by active persons who are not sick enough for bed. It affects 
members of every walk of life, and may be so severe as to entirely 
incapacitate the most powerful men. 

The causes of neuralgia are very various, but they may be briefly 
stated to depend chiefly upon malnutrition and anaemia, over-work, 
nervous excitement with consequent reaction, and upon reflex irritation 
from diseased organs, as in the case of supraorbital neuralgia from 
eye-strain or ovarian irritation or uterine inflammation. Nerves 
functionally diseased are always more or less active than normal ; 
that is, hyper-excited, or depressed, above or below par. In both 
cases they must be brought back to their normal tone by appropriate 
remedies, and these consist in nervous excitants and nervous seda- 
tives. To give a nerve already depressed the additional depression of 
a bromide, or a nerve excited the additional excitement of strychnine, 
is harmful. 

From what has just been said, it becomes evident that the physician 
must always determine the condition of the system of his patient and 
the causes of that condition before administering remedies. 

The treatment of neuralgia, from its curative standpoint, may be 
divided into the use of tonics, nutritives, and palliatives. 

W here neuralgia is associated with anaemia no hope of permanent 
relief can be looked for unless iron and arsenic are used until the 
anaemia is cured, and it is often necessary to combine with these 
drugs the use of cod-liver oil and bitter tonics. These are the cases, 
too, in which mix vomica and strychnine raise the depressed nerves 
to increased activity, and so bring relief. How they do this is not 
known, but we know enough to recognize one or two important facts. 
Strychnine is certainly a nervous stimulant, and is also a stimulant 
to the anterior columns of the spinal cord. It probably also acts 



NEURALGIA. 701 

upon the trophic centres in the anterior cornua of the spinal cord, 
and by stimulating these centres increases the nutrition of the trib- 
utary nerve-fibres. 

It is needless to state that the neuralgias of syphilis and scrofulosis 
are to be treated by the specific remedies directed to the cure of these 
affections, while at the same time the various symptoms are carefully 
controlled by appropriate palliatives. 

When nervous exhaustion causes neuralgia, phosphorus is a useful 
remedy, particularly in those cases which are convalescing from acute 
fevers. 

Sometimes malarial poisoning produces a violent form of supra- 
orbital pain known as "brow ague," which is to be relieved, not by 
ordinary remedies, but by large doses of quinine. 

The relief of the states producing neuralgia having been spoken 
of, it yet remains for us to consider the measures to be adopted for 
the cure of an attack. Fortunately, the recent advances of thera- 
peutic study have placed in our hands a large list of drugs not apt to 
produce a habit after prolonged use, comparatively safe though active, 
and not of disagreeable taste or evil general effect. By the'se terms 
the writer refers to antipyrin, acetanilid, citrophen, and phenacetin, 
all of which possess wonderful power in the alleviation of pain de- 
pendent upon true nervous involvement. In order to avoid failure in 
the use of these drugs in the relief of headache, we must always 
remember that their field of service is that of neuralgic pain, not other 
pains. Antipyrin is to be used in the dose of 5 to 15 grains (0.13— 
1.0) for ordinary neuralgia and more for the pain arising from the 
crisis of locomotor ataxia, acetanilid in the dose of 3 to 8 grains 
(0.18-0.5) for the same purposes, and citrophen and phenacetin in the 
same amount as acetanilid. 

Upon these remedies, combined with caffeine and the bromides 
according to circumstances, w T e now depend, and the following pre- 
scriptions will be found of service : 

R — Antipyrini £j vel gij (4.0-8.0). 

Caffeinse citratis . gr. xx (1.3). — M. 

Ft. in chart No. x. 
S. — One every thirty minutes till relieved. 

The following may be of use also : 

R .—Antipyrini » 3J vel ^ij (4.0-8.0). 

Potassii bromidi giij (12.0). — M. 

Ft. in chart No. x. 
S. — One every thirty minutes till relieved. 

Or, when the caffeine in the first prescription causes nervousness, 

R— Antipyrini £j vel 31J (4.0-8.0). 

Caffeinse citratis gr. x (0.65). 

Potassii bromidi giij (12.0). — M. 

Ft. in chart No. x. 
S. — One as above. 

In any one of these prescriptions acetanilid or phenacetin may be 
substituted for the antipyrin. 



702 DISEASES. 

A very effective remedy in some cases of neuralgia of the fifth nerve 
is croton chloral in from 5- to 20-grain (0.3-1.3) doses in pills of 5 
grains (0.3) each. 

In some cases of anaemic neuralgia of the head nitrite-of-amvl 
inhalations have proved useful, probably by reason of the cephalic 
flushing produced by this drug. 

A very large number of local applications have been used with 
success in obstinate neuralgias and other cases not so difficult of cure. 
Cocaine cannot be applied, as it does not penetrate the skin, but relief 
can sometimes be obtained by the local use of the oleate of aconitine 
painted over the spot if it be limited in area. Much of this alkaloid 
cannot be applied, lest poisoning by absorption occur. 

Where the nerve is very superficial it can often be treated by cold 
with great success. This is accomplished by freezing the parts with 
an ether, chloride of methyl, or rhigolene spray, or by the application 
of a small package of finely-chopped ice and salt to the part. Within 
the last few years the treatment of neuralgia by JcatajyJwresis (see Part 
III.) has come into prominence, and consists in the use of some local 
anaesthetic, such as chloroform, which is applied over the part on a 
small piece of lint, and a galvanic current used through the pledget 
which is attached to the positive pole. Under these circumstances the 
anaesthetic passes through the skin and affects the nerve. 

A very useful local injection in localized neuralgia is -1- to 1 of a 
grain (0.016) of morphine, but the danger of beginning the morphine 
habit is to be remembered when treating chronic cases. Sometimes 
acupuncture (see Part III.) is of service, and the surgeon may be 
called upon to stretch the nerve or to do a neurectomy. 

In some cases repeated doses of castor oil. 1 to 2 ounces (30.0-60.0) 
a dav. seem to exercise a very extraordinary influence in relieving neu- 
ralgic pain. Such cases probably depend upon deficient activity of 
the bowel with retained toxic material which gains access to the blood. 

There still remains to be considered a form of neuralgia generally 
known as migraine. This affection is very severe in its manifesta- 
tions, and is often most obstinate in yielding to treatment. Com- 
monlv it is associated with eye-strain or cerebral disease, or due to the 
so-called uric acid diathesis; and these causes must be removed before 
a cure is, entirely effected. A useful plan to produce this result is the 
use of the salicylates. The best treatment of most of these attacks 
is the use of one of the coal-tar preparations or of 20 minims (1.3) of 
the tincture of cannabis indica every hour if a good preparation can 
be had. or by the use of \ to \ grain (0.016-0.30) of the solid extract 
every two hours, accompanied by 10 to 20 minims (0.65-1.3) of tinc- 
ture of gelsemium. (See article on Headache.) 

NIPPLES (SORE). 

Whenever the nipples become sore, so that it is impossible for the 
mother to allow the child to nurse, a solution of cocaine of the 
strength of 4 grains to the ounce (0.2 : 30.0) should be applied to the 

part, and washed off carefully just before the child sucks. Following 



OBESITY. 703 

the nursing, a solution of boric acid, of the strength of 20 grains to 
the ounce (1.3 : 30.0) of water or mucilage of acacia, may be used 
over the part, the nipple being first thoroughly dried. Where the 
fissures are deep and slow to heal the tip of a stick of silver nitrate 
may be applied to them with advantage. Some practitioners employ 
tincture of benzoin over the inflamed part, and glycerite of tannin is 
often of value. Cleanliness, dryness, and care of the breast previous 
to parturition do much toward preventing the condition. 

Sometimes it is necessary to use a breast-pump or nipple-shield 
before a cure can be effected. 

OBESITY. 

Whenever an excess of fat accumulates in the body, various dis- 
comforts, both mental and physical, arise, and in addition the normal 
functions of all the parts are so disturbed or interfered with that the 
continuance of health is often impossible. In many cases the deposition 
of fat about the heart or between its fibres results in serious symptoms ; 
and breathlessness on exertion is produced by the obstruction which is 
offered to the free movements of the diaphragm by masses of omental 
fat, aided by the fact that the great weight and bulk of the body 
requires severe muscular effort. It is worthy of note, also, that a layer 
of fat over the body increases the vascular surface very greatly, and in 
consequence gives the heart the labor of supplying a larger number of 
blood-vessels. 

The causes of obesity are numerous. In many families there is an 
inherited tendency, while in others only certain individuals are affected. 
These persons are fat because their systems naturally tend to the de- 
posit of obese materials, in the same way that the members of one 
family have large bones, while those of another have a small frame. 
The etiological causes of obesity, outside of those just named, are very 
numerous, but the chief one is over-indulgence in food. 

Just at this point it is not out of place to state exactly what over- 
indulgence in food means. Every individual is a law unto himself 
in regard to the amount of food which is consumed and ingested. 
One often sees large, powerful, wiry men, who eat little, sit beside 
others, not so powerful or large, who eat excessively, and who appa- 
rently do not suffer from indigestion in consequence. Neither of these 
two groups becomes excessively fat, because one represents a grate 
which burns its fuel so that there is no waste, while the other resem- 
bles a grate in which there is always a residue of unburnt coal, which 
is cast out with the ashes as effete matter. As different engines of 
the same build require varying amounts of coal, so do different men 
assimilate different amounts of food. No stated amount of food can 
be set down as a man's daily portion until his case is carefully 
studied, but it is important to remember that the quantity of food is 
generally in direct ratio to the severity of the toil, and that a man 
who loafs about a club or " takes life easily " often eats more than a 
day -laborer — of far richer foods, too — and wonders why he gets stout. 
In nearly every case of obesity not dependent upon gross disorder 



704 DISEASES. 

of the trophic nerves over-indulgence in food is the cause. To some 
this may seem absurd, and the patient will say that he eats just 
enough to keep him from feeling empty between meals ; but this does 
not alter the case in the least. The proper amount of food for a man 
is not what his appetite or gastric viscus calls for, but what his sys- 
tem needs. To this further reference will be made when considering 
the diet for obesity, found below. 

The very presence of fat aids in the deposition of it, for, by act- 
ing as a non-conducting pad all over the body, it prevents the dissi- 
pation of heat, and so decreases the combustion of those substances 
which, when not used for the manufacture of heat, are deposited as 
fat. Again, we nearly always find that obese persons take alcohol 
with their food, thereby increasing the fat in their bodies ; for, find- 
ing that they cannot digest all the substances which greediness makes 
them swallow, they take alcohol to stimulate their digestive apparatus 
to increased efforts and assimilation. Further than this, alcohol adds 
force to the body, and preserves the tissues by substituting itself for 
food in the oxidizing processes. 

We find, therefore, that three great causes are active in producing 
corpulence in many cases — namely, heredity, over-indulgence in food, 
and lack of exercise, which is one of the means by which over-indul- 
gence is produced; i. e. less exercise, less food needed, but often more 
eaten. 

The treatment of corpulence rests solely upon the conditions named. 
In all instances the diet is the important point for the bestowal of 
care. Reference has already been made to the fact that the needs of 
the system are the criterion by which we judge the amount of food 
necessary to each case, not the sensations in the stomach. The use of 
coca by the natives of South America enables them to withstand 
hunger and privation, not because it gives tissue to the body, but 
because it paralyzes the sensory nerves in the stomach and relieves 
the sensation of hollowness or weakness which we are accustomed to 
overcome in this country, in the absence of food, by tightening our 
belts. Every one who has undergone severe mental or physical labor 
and missed a regular meal will remember that about the usual hour 
for the meal his sensation of emptiness may amount to nausea and 
distress, but the hour once passed he feels as strong as before until 
by prolonged toil he so exhausts his powers that the system forces 
him to eat, not so much from hunger as from exhaustion. To under- 
stand this clearly, we must recollect that the system keeps its shares 
of force in the same way as a careful speculator keeps his shares of 
stock — namely, one part in active use for speculation, the other half 
for reserve in case of need. In health the stomach begins to " feel 
hungry " as soon as the speculative shares of force are nearly used, 
in order to cause the ingestion of more food and to preserve the 
" sinking fund " intact. It becomes evident, therefore, that the mere 
presence of hunger is purely a symptom, not an indication of the 
absolute necessity of food, for, if it were, the consumptive would 
be notorious for his appetite, instead of being noteworthy for his 
anorexia. 



OBESITY. 705 

The food of the patient suffering from obesity is to be cut clown 
gradually, and the character of it arranged so that, though its bulk 
be great, its nutritive properties are small. Beef and other meats 
are concentrated foods containing much nourishment in a .small space, 
while lettuce, spinach, cabbage, and nearly all vegetables, except 
roots or tubers, contain a large amount of fibre useless to the body. 
By the use of a carefully arranged vegetable diet in obesity we cut 
down the actual amount of food absorbed, and by its bulk keep the 
stomach so busy at sifting the nutritious from the non-nutritious mate- 
rials that hunger is not felt, because another meal-time is reached 
almost before the food of the first is assimilated. We find, therefore, 
that the diet for the reduction of corpulence should consist chiefly 
of bulky vegetables, but not too exclusively of any one article or 
set of articles. Heretofore it has been thought that proteids (meats, 
eggs, etc.) should be used to take the place of all hydrocarbons or 
carbohydrates (fats, starches, and sugars), but this is not physiologi- 
cally correct, as both forms of food are always needed fcr health, and it 
has been found that proteids may be converted into fats in the body. 

The following bill of fare will be found of service in the treatment 
of obesity : 

Breakfast : One or two cups of coffee or tea, without milk or 
sugar, but sweetened with a fraction of a grain of saccharin. 3 
ounces of toasted or ordinary white bread or 6 ounces of bran bread. 
Enough butter may be used to make the bread palatable — not more 
than 1 ounce. Sliced raw tomatoes with vinegar or cooked tomatoes 
without any sugar or fats. This diet may be varied by the use of 
salted or fresh fish either at breakfast or at dinner. This fish must not 
be rich like salmon or sword-fish, but rather like perch or other small 
fish. 

Noon meal (dinner) : One soup-plate of bouillon, consomme, Ju- 
lienne, or other thin soup, or Liebig's or Mosquera's beef jelly, fol- 
lowed by one piece of the white meat of any form of fowl or a small bird. 
Sometimes a small piece, the size of one's hand, of rare beef or mut- 
ton, but no fat, may be allowed, and this should be accompanied by 
string-beans, celery, stewed or raw, spinach, kale, cabbage, beans, 
asparagus, leeks, and young onions. Following this, lettuce with 
vinegar and a little olive oil (to make a French dressing), a cup of 
black coffee or one of tea, and a little acid fruit, such as some sour 
grapes, tamarinds, and sour oranges or lemons, may be taken, and 
followed by a cigar or cigarette. 

Supper should consist of one or two soft-boiled eggs, which may 
also be poached, but not fried, a few ounces of bran bread, some 
salad and fruit, and perhaps a glass or two of light, dry (not sweet) 
wine, if the patient is accustomed to its use. 

Before going to bed, to avoid discomfort from a sensation of hun- 
ger during the night, the patient may take a meal of panada or soak 
Graham or bran crackers or biscuits in water and flavor the mass 
with salt and pepper. 

The reduction of diet is generally best accomplished slowly, and 
should be accompanied by measures devoted to the utilization of the 

45 



706 DISEASES. 

fat present for the support of the body. Thus the patient should not 
be too heavily clad, either day or night, should resort to exercise, 
daily becoming more severe, and should not drink freely of water, 
unless sweating is established sufficiently freely to prevent the accumu- 
lation of the liquid in vessels and tissues. 

Very often a cold bath will, by its dissipation of heat, cause 
destruction of fat, which will be burnt up in the body in the manu- 
facture of heat-units to maintain the temperature ; and if the patient 
is not too anaemic and stands this exposure to cold well, the bath 
should be repeated each day or a Turkish bath used instead. 

The bowels should be kept active by laxative fruits or purges, but 
if liquids taken in drink are not eliminated rapidly, saline purges are 
useful, since, if the blood-vessels are engorged, the circulation in the 
capillaries is slow and a deposit of fat is apt to result. 

Where proper exercise is impossible the rest cure, with massage, 
electricity, passive exertion, and an absolute skimmed-milk diet, may 
be resorted to, particularly in those persons known as "fat anaemics," 
who have not enough red corpuscles in their blood to carry sufficient 
oxygen to the tissues to complete oxidation. 

!So far as medication is concerned, the great value of thyroid gland 
in some cases is not to be forgotten. (See Part II.) 

PERICARDITIS. 

Inflammation of the pericardial sac requires prompt treatment. If 
the case be sthenic and is seen early, and the heart is overacting, five 
to ten leeches should be placed over the pr^ecordium, and at the same 
time sufficiently large doses of veratrum viride or aconite resorted to to 
depress the circulation, and by the dilatation of the blood-vessels else- 
where to draw off the blood from the inflamed area. To prevent the 
outpouring of a plastic exudate capable of undergoing organization 
and forming adhesions, calomel should be given in -J-grain (0.03) doses 
every hour till several grains are taken, combined with enough opium 
to prevent purgation. An ice-bag placed over the praecordium not 
only relieves the pain, quiets the circulation, and reduces the temper- 
ature, but also acts favorably in modifying the severity of the inflam- 
mation. In other instances several small fly blisters are useful. 

Where the case passes from the acute stage of inflammation to that 
in which effusion takes place, the treatment changes at once, and 
becomes supportive if the system shows signs of failure. The friction- 
sounds of the first stage are now lost, and the heart-sounds may be 
feeble or muffled by reason of the effusion present. Digitalis, alcohol, 
or caffeine may be used if the heart show signs of failure, but when 
digitalis is used its influence should be carefully watched, since the 
employment of this drug produces a very full diastole or dilatation of 
the ventricles, and these are already cramped for space in which to 
dilate by reason of the exudate which lias entered the pericardial sac. 
If the effusion is sufficient to endanger life, it should be tapped and 
aspirated away very gradually. Often it is best to use a long needle 
attached to a hypodermic syringe in order to be sure that there is fluid, 



PERITONITIS, ACUTE. 707 

but the greatest care must be taken that the heart "is not wounded. 
After the skin is punctured a dull canula should be pushed into the 
sac, as a sharp one may wound the heart. The best place for making 
the puncture is the fourth or fifth intercostal space, very close to the 
left edge of the sternum. In other instances, if the patient is strong, 
it is only necessary to administer hydragogue purges, such as jalap (20 
grains [1.3] of the compound jalap powder), or elaterium -J- grain 
(0.01), or a saline purgative in concentrated form, before breakfast. 
Often a blister over the prsecordium is of service in aiding absorption. 
Should pus be present, free drainage must be established by means 
of an incision, and it may be necessary to excise the sternal end of 
the fifth rib on the left side. 

PERITONITIS (ACUTE). 

The views of the best minds in the medical profession concerning 
the treatment of peritonitis have changed radically in the last ten 
years, chiefly through the advances made in abdominal surgery and 
bacteriological research. These opportunities for study have shown 
that peritonitis never arises as a strictly primary condition, but is 
due in every case to the infection of the peritoneum by micro-organ- 
isms, benign or malign, which are originally found in the intestines 
or other portions of the abdominal viscera. Even when peritonitis 
follows directly upon injury, the actual cause of the pathological 
process is the escape of micro-organisms through the devitalized wall 
of the intestine, and the severity of the attacks depends in turn upon 
the vital resistance of the patient, the degree of infection, and the 
rapidity with which a plastic exudate is thrown out to encapsulate 
the inflamed area. 

It is not possible in this short article to discuss the facts now 
known in regard to the etiology and pathology of acute peritonitis. 
Suffice it to state, one of the germs found normally as a benign 
inhabitant of the intestine becomes at once, on entrance into the 
peritoneal cavity, malignant and capable of producing rapidly-fatal 
peritonitis. Nor is actual rupture of the bowel or appendix vermi- 
formis necessary for this infection, since it has been shown that this 
germ, the bacillus coli communis, rapidly migrates through the bowel- 
wall as soon as it becomes inflamed or congested in all its coats. 
Streptococci and staphylococci, finding access to this cavity, also 
produce violent inflammation. It has been found that the perito- 
neum will destroy many infecting germs in the healthy man if its 
vitality is not impaired, but if it is impaired a mild infection starts up 
severe inflammation. 

Having learned, then, that acute peritonitis is always secondary to 
some local cause or to some general infection, the first thing for the 
therapeutist to do, being called in to a case of this disease, is to deter- 
mine what the provoking agent is, in order that his treatment may 
be directed against the cause rather than the effect. This cause is 
now known, in the great majority of cases, to be Appendicitis (which, 
see), the inflammatory process being spread by infection from this 



708 DISEASES. 

source. In women it is not uncommonly due to more or less obscure 
pelvic disease, or, again, it may arise from abscess and other severe 
diseases of the liver, spleen, pancreas, or stomach. Finally, it should 
never be forgotten that intestinal obstruction is a frequent cause of 
peritonitis. The physician may rest assured that if he cannot find 
the provoking cause, it is his own fault, and not that the case is purely 
idiopathic. 

Having found the cause, treatment is of course to be at once insti- 
tuted, and is medical or surgical — more commonly the latter than the 
former, since nearly all the provoking causes of this disease are at 
most only palliated by medicinal treatment, while they can sometimes 
be removed by surgical interference. Fortunately for those who can 
only obtain medicinal treatment, nature does much to aid in produ- 
cing a cure in many cases by limiting the disease through its localiza- 
tion by walls of lymph, so that many cases of peritonitis recover with- 
out active medicinal or surgical care. In the pelvis this localization 
of the process is very apt to take place unless the infection follow 
childbirth, when septic diffuse peritonitis may arise, which is nearly 
always fatal unless surgical assistance is obtainable. 

If the trouble arise in the appendix vermiformis, this condition 
may be treated in its early stages by the means suggested in the article 
on Appendicitis, but at the very first sign of the spread of the inflam- 
mation, or of its becoming locally very severe, or of general systemic dis- 
turbance, the surgeon must be called in. The difficulty is that in many 
cases requiring operation the operation is performed too late through 
the hesitancy of the patient, his friends, the physician, or even of the 
operator himself. If the local trouble does not seem to be spreading 
and the patient's general condition is favorable, operation should be 
postponed indefinitely or until a state of quiescence is reached, when the 
prospects of recovery from operative interference are better. If there 
is reason to believe that an abscess has ruptured into the peritoneal 
cavity, or if perforation of the bowel is suspected or shown to be pres- 
ent by severe general symptoms of widespread peritoneal involvement, 
operation should be resorted to at once. 

In deciding the question, however, as to whether a case of periton- 
itis requires surgical interference, the physician at the present time 
is" in an unfortunate position. There can be no doubt that there are 
many records in medicine which prove most conclusively that lives 
have been saved through operative interference which would have 
been undoubtedly lost had the surgeon not come to the rescue. On 
the other hand, there are cases in which a fatal result has followed 
an operation, and in which the physician has bitterly reproached him- 
self that he consented to surgical interference, for as he looks back 
over the case he perceives that the operation has distinctly aided in 
causing the loss of life. At the present time each case must be 
decided upon its individual merits, and the physician or surgeon in 
giving advice to the family in regard to a well-developed case of peri- 
tonitis should always be careful to let them understand distinctly that 
the condition of the patient is most alarming, and the chances of life 
poor whether the treatment be medical or surgical, since in many 



PERITONITIS, ACUTE. 709 

instances neither form of remedial measure can possibly produce good 
results. In other words, the relatives should clearly understand that 
whether medicinal measures or surgical procedures are resorted to, the 
patient has only a fighting chance. 

The following case illustrates the value of surgical interference in 
peritonitis : 

M was taken ill at twelve midnight, with violent pain in the 

belly, and was seen by the writer the following evening at eight 
o'clock. At this time all the physical signs of a widely-diffused 
peritonitis were present. The belly was hard and board-like, the 
pulse was exceedingly rapid, the respirations fifty-six, and there was 
great pain. Careful physical examination of the belly and a study 
of the patient's history failed to reveal any cause near or remote for 
the attack, he having been in perfect health up to the time at which 
the pain began. After consultation with an eminent surgeon it was 
decided that his condition was so pressing that death under medicinal 
treatment was assured, and that, while operative interference offered 
but a faint chance of success, it was the only measure which could be 
resorted to. Accordingly, at twelve o'clock that night, just twenty- 
four hours after the pain began, the patient was operated upon, the 
incision being made in the median line for the purpose of exploring 
the belly, with the hope that an exciting cause for the attack might 
be found. On opening the belly it was found that acute intestinal 
obstruction had taken place through the bowel being twisted over an 
old inflammatory band. After this obstruction had been reduced the 
appendix was examined, and found to be in a condition of acute in- 
flammation, and for this reason it was removed. It was noted that 
the peritoneal surfaces of the intestines and of the abdominal wall were 
intensely hypersemic and red, and lacking in their normal appearance. 
The operation lasted an hour and a half, and the patient recovered 
after a desperate struggle for life which lasted for weeks, during 
which time his attendants several times gave up all hope of his re- 
covery. Had no operation been permitted, death would certainly have 
resulted from the intestinal obstruction if not from the appendicitis, and 
had the median incision not been made, but the appendix alone sought 
for by a lateral incision, the obstruction would have been overlooked, 
and the death recorded as one due to general peritonitis following 
appendicitis for which an operation had been performed unsuccessfully. 

On the other hand, the writer saw a case in which the conditions 
before operation were apparently identical with that just named, in 
which appendicitis and obstruction were discovered at the operation, 
and in which death took place as early or earlier than it would have 
occurred had operative interference not been resorted to. These two 
cases are mentioned for the purpose of emphasizing the fact that a 
definite prognosis as to the results of treatment, either surgical or 
medicinal, in peritonitis is not possible. 

Aside from the surgical treatment, which is an absolute essential in 
many cases of peritonitis, we have at hand medicinal methods which 
are of some value early in the attack and where operation is refused 
or considered inadvisable. The first of these is the use of opium, 



710 DISEASES. 

given until the pain is partly removed and the respirations decreased 
to twelve or fourteen per minute. The patient should never be 
so narcotized as to have no pain on abdominal palpation or be 
unable to answer questions. On the other hand, it should be 
remembered that cases of peritonitis bear large doses of opium 
without effect. The dose should be pushed till the desired effect 
is obtained, and not be measured in grains. Cases are on record 
in which many hundred grains of opium have been given in a few 
days, with recovery as a result* (For the proper use of opium see 
Appendicitis.) 

For many years physicians of repute have regarded mercury as 
the drug above all others capable of modifying inflammations of 
serous membranes, particularly if combined with opium, but this 
method of treatment has recently passed out of vogue. An ice- 
bag or a turpentine stupe may be put over the the area originating 
the trouble. If the case is very sthenic, leeches may be used on the 
belly, but this is not advisable in most cases, as the patient may later 
need the blood to preserve his strength. Should vomiting be a press- 
ing symptom, it is best controlled by the use of two grains of ace- 
tanilid every two or three hours with brandy and ice. Medication is 
best carried out by the hypodermic needle or the rectal injection. 
The thirst in many cases of peritonitis is excessive, and ought to be 
relieved by giving small pieces of ice with or without a little white 
of egg poured over them. Even small amounts of water are not to be 
forbidden, since the vomiting is reflex, and the water allows the vom- 
iting to take the place of the more exhausting retching. If collapse 
is threatened, the best remedy is probably the extract of hyoscyamus 
by the rectum in injection or suppository, since this drug, while it 
contracts the vessels and soothes the nervous system, does not tend 
to produce disagreeable symptoms as does belladonna. 

The question of the use of purgatives in cases of peritonitis has 
been much discussed. The writer believes that in cases of perito- 
nitis following operation, where the operator knows the intestine is 
intact, saline purgatives, such as teaspoonful doses of a saturated 
solution of magnesium sulphate every ten or fifteen minutes, may 
be used in many cases with good effects ; but if there is any pos- 
sibility of the peritonitis being caused by perforation or obstruc- 
tion, their use is absolutely contraindicated, since if used the con- 
tents of the gut may be washed into the peritoneal cavity or the 
obstruction be rendered more complete. The saline purgative not 
only empties the bowel, but in addition, by the free watery flow pro- 
duced, depletes the inflamed peritoneum. When there seems to be a 
probability that the pain may be due to the ingestion of bad food, 
and signs of perforation are absent, purgatives may be used to remove 
the offending articles. Should the patient be feeble, purgation is 
contraindicated. 

The tympanites, which may be a prominent symptom, may be 
relieved in sonic cases by the use of the rectal tube or of injections 
into the bowel of milk of asafcetida or turpentine emulsion. 

This book is not the place for the consideration of the surgical 



PERITONITIS, CHRONIC— PERNICIOUS MALARIAL FEVER. 711 

procedures to be followed, but it may be stated that in septic peri- 
tonitis in all cases it is a question of operation with probable death, 
or no operation with certain death. In obscure cases of general peri- 
tonitis, where the cause of the disease cannot be found by ordinary 
methods of diagnosis, the writer believes that exploratory incision 
should be done, and after the cause is removed the belly-cavity well 
washed out with hot normal saline solution, and drainage-tube or 
gauze left in for at least twenty-four hours. 



PERITONITIS (CHRONIC). 

Chronic peritonitis is very apt to be circumscribed and to exist in 
connection with chronic appendicular trouble or in females in connec- 
tion with diseases of the organs of generation. The most diffuse and 
curable form of the disease is that known as tubercular peritonitis, in 
which cures have been safely reached through abdominal incision with 
or without drainage or the dusting in of iodoform. Of all forms of 
organic disease affecting the abdominal area and of a chronic type, 
none offer such results to the physician and surgeon as does this, and 
operation ought always to be advised and urged upon the patient most 
strenuously. Care should be taken, however, to separate the subacute 
or chronic process, termed tubercular peritonitis, from the malignant 
and acute form called tuberculosis of the peritoneum, which is often 
only a manifestation of a general infection. 

PERNICIOUS MALARIAL FEVER. 

This is one of the most acutely dangerous diseases known to man 
if it be fully developed, and requires the greatest activity and skill 
on the part of the physician, who may be called upon to treat a large 
number of widely varying symptoms, all of a pressing nature, at one 
and the same time. The chief indication is for the use of quinine in 
its most soluble forms, in solution and in large doses, which may 
be given hypodermically or intravenously. (See Cinchona.) 

As a rule, the use of the drug by the mouth is futile because the 
state of the stomach is such that absorption will not take place, at 
least till after the attack has done its damage. The hypodermic or 
intravenous use of the drug is therefore advisable. Given in this 
manner doses ranging from 10 to 15 grains (0.65-1.5) may be used 
with safety. If more than this is given intravenously, the dose must 
be given very slowly, and preferably divided into several smaller 
doses lest cardiac depression ensue. If the attack be of the hema- 
turic or hemoglobinuric type, quinine is to be used with the greatest 
caution, or not at all. (kSee Cinchona.) The patient should be treated 
by the use of 60-grain (4.0) doses of hyposulphite of sodium every 
two or three hours till the bowels are moved freely. Copious draughts 
of pure water, with or without lemon-juice added, are to be given to 
flush the kidneys, and if necessary morphine and atropine are to be 
given hypodermically to control the retching and vomiting. 



712 



DISEASES. 



PLEURITIS, OR PLEURISY. 

The treatment of this disease in its acute form in its early stages is 
identical with that of other inflammatory affections. In other words, 
the use of venesection, or, better still, of tincture of veratrum viride 
or aconite, to bleed the man into his own blood-vessels, is to be re- 
sorted to if the patient is seen in the very earliest stages and has a 
bounding pulse. If the circulation is not bounding, these drugs should 
not be used. 

When the pain from the pleurisy is excessive and the movements 



Fig. 104. 





Showing the overlapping of the adhesive strips in strapping the chest for painful pleurisy. 
The strips extend too far to the right. 



of respiration greatly increase the discomfort, strapping the chest- 
wall may be resorted to. This is done for the purpose of immobil- 
izing the chest. The straps should consist of adhesive plaster, two 
and a half inches wide, and should be long enough to reach from 
the middle line of the. vertebrae to the sternum or a little beyond its 
middle line. They should be applied tightly during expiration, 
slightly overlapping one another at a right angle to the spine, and 
not in the line of the ribs. (Fig. 104). 

The old idea that pleurisy was usually due to cold rather than to an 
infecting micro-organism led to the enveloping of the chest in poultices. 



PLEURITIS, OB PLEURISY. 



713 



These soil the clothing, speedily get cold, and are very uncomfortable. 
They have been supplanted almost entirely by the cotton jacket, which 
is much better. It consists of one or two thicknesses of carded cotton 
basted inside a thin undershirt, as fur is placed in a fur-lined coat. 
On the outside of the shirt oil-silk should be basted. By using this 
we envelop the chest in a warm poultice, because the heat of the body 
keeps the cotton at the proper temperature, while the oil-silk, by pre- 
venting evaporation of the moisture exhaled from the skin, soon causes 
the cotton to be moist as well as warm. Even the cotton jacket is 
losing its popularity, as the fever of the patient makes a hot jacket 
almost unbearable and it does very little real good. Further, its re- 
moval is very apt to result in exposure to cold. 

When the pleurisy has fully developed other lines of treatment are 
needed. The cardiac sedatives have been stopped as soon as the quiet- 
ing of the circulation has been accomplished. If the pulse becomes 
weak and the system is depressed, stimulants in the form of alcohol or 
digitalis are needed, and special care must be devoted to the condition 
of the exudation in the pleural space. If the effusion is sufficiently 
large to cause marked dyspnoea on exertion, or reaches to the third 
interspace anteriorly, it should be removed by aspiration. When the 
effusion is not causing dyspnoea, or other evil symptoms by reason of 
pressure, the physician should allow sufficient time for recovery to 
occur ; as, for example, a week or ten days, during which interval the 
system will in many cases remove the fluid by natural processes of 
absorption. If after this time has elapsed the fluid remains, it is wise 
to give salicylic acid in the dose of 1 to 2 drachms (4.0-8.0) a day, or 
saline purges given in the early morning in concentrated form, and 
finally, if the fluid is not taken up by the vessels after jalap or elaterium 
is used, resort must be had to aspiration of the liquid. They ought 
never to be employed to such a degree as to weaken the patient, and 



Fig. 105. 




Arrangement of bottles for promoting lung expansion. 

in most cases this is a necessary evil if the purgative is active enough 
to be at all effective in withdrawing liquid from the body-cavities. In 
his own practice the author rarely uses these drugs, but resorts at 
once to aspiration. 



714 DISEASES. 

In cases in whichit is desired to attempt the removal of a pleural 
effusion by the use of purgatives and diuretics, and it is doubtful if 
absorption can go on through the pleura, we may inject 10 grains of 
methylene blue into the chest, give the purgative, and examine the 
urine for the blue. If it is eliminated, absorption is possible ; if not, 
the removal of the fluid by the aid of purgatives is very doubtful. 

In order to cause proper expansion of the lung after convalescence 
is begun, chest exercises should be used (see Part III.) and wash- 
bottles may be employed, as are shown in Fig. 105 

There is no danger in aspiration, if it is properly performed. 
The best place to insert the needle is the sixth or seventh interspace 
in the middle axillary line. Care should be taken that the needle is 
aseptic ; that the skin at the point of puncture is well cleansed ; and 
that the exhaust-pump is working well. All the fluid should not be 
withdrawn at one sitting. Often the withdrawal of a portion of it will 
result in the natural absorption of the quantity which is allowed to 
remain in the chest. 

The physical signs at this time, it will be remembered, con- 
sist in flatness on percussion over the lower portions of the chest, 
which area of flatness generally varies with the change in the position 
of the patient from the erect to the recumbent position, unless the effu- 
sion is sacculated. Blowing or bronchial breathing at the apex of the 
lung, when this organ is compressed upward by the fluid beneath it, is 
often heard. If the effusion is on the right side, the apex-beat of the 
heart is apt to be displaced to the left. If it is on the left side, there 
is obliteration of Traube's semilunar space, which is a spot at about 
the level of the sixth and seventh ribs anteriorly below the nipple, 
where there is usually a tympanitic note on percussion. 

During this stage of effusion blisters have been largely used in aiding 
in the absorption of the liquid which is present, but they are not of great 
service. When used they should be applied in the form known as fly- 
ing blisters. (See Cantharides, Part II.) It is to be remembered that 
blisters are, as a rule, contraindicated in the case of children, because of 
the pain and irritation they produce. If a pleural effusion in the chest 
of a child is not absorbed by natural processes, it is best to aspirate it. 

If the fluid is purulent, it must be removed by making an inter- 
costal incision and draining the abscess cavity, although if the dis- 
placement of the heart is great we should first aspirate to relieve 
pressure and operate afterward. 

PLEURODYNIA. 

This condition, being one of intercostal neuralgia, should be treated 
according to the directions given under the headings of Neuralgia 
and Counter-irritation. 

PNEUMONIA. 

Pneumonia is a term loosely applied to two very different forms of 
disease — namely, that acute infectious process due to an infection by the 






PNEUMONIA. 715 

micrococcus lanceolatus and called croupous pneumonia, and that form 
following as a rule some other disease which has exhausted the patient's 
strength and due in some cases to various forms of infection, namely, 
catarrhal pneumonia. These two distinct diseases have been confused 
by the common term pneumonia, and yet are very different conditions 
as to their pathology and treatment. 

Croupous Pneumonia. 

Croupous pneumonia usually attacks the strong and hearty rather 
than the feeble and exhausted, but both types of cases may be affected. 
The treatment can be divided, when we study it, into that devoted 
to the stage of onset, the stage of consolidation, and the stage of ab- 
sorption of the exudate and convalescence ; and it will be governed 
by the state of the patient's pulse, the sounds of his heart, and his 
general condition as to strength, as well as the degree of respiratory 
embarrassment which is present. There can be no routine treatment 
of croupous pneumonia ; each case must be a law to itself, and there is 
no such thing as the depletant treatment to be advocated on the one 
hand, or the stimulant treatment to be lauded on the other. Further 
than this, it must be remembered that as croupous pneumonia is an acute 
infectious disease the patient may die not from pulmonary consolidation 
or cardiac distention, but from the malignancy of the infection. One 
man with an entire lung consolidated may have slight evidences of 
general infection or toxaemia, another with a small area of lung involved 
may be overwhelmed by toxgemia within a few hours. For this and 
other reasons we can divide all cases of croupous pneumonia into three 
groups — those that are doomed to death by the malignancy of the in- 
fection, those that are but slightly ill by reason of mild infection, and 
those who between these two extremes of severity need careful medical 
aid to accomplish recovery. The first class die do what we will, the 
second class get well almost without help, the third need all the help 
possible to survive. It is to this last class that our treatment must be 
chiefly directed. 

In the very earliest stages of the disease occurring in a healthy, 
sthenic individual who has been seized with a chill followed by fever 
and a bounding, angry pulse, with marked anxiety and nervous excite- 
ment, it is proper to freely bleed from a vein in the arm to the extent 
of a pint (see Part III.), or in its stead to use veratrum viride or aco- 
nite to relax the systemic blood-vessels and " bleed him into his own 
vessels" by making it easier for the blood to pass into the general 
arterial system than into the lung which is inflamed. These sedative 
drugs also quiet the excited heart and prevent it from pumping so 
much blood into the engorged lung. A hot foot-bath at this time will 
also tend to relieve thoracic congestion. If veratrum viride or aconite 
is used, it should be given in minim doses of the tincture every 
half-hour till five or ten doses have been used or until the patient's 
pulse becomes less angry and his skin becomes moist. Veratrum 
viride is the best drug of the two for adults. If violent pain in the 
chest is present, it is to be relieved by small doses of morphine or 



716 DISEASES. 

Dover's powder. This treatment is devoted to an attempt to limit the 
degree of inflammatory action as far as possible. It may be aided, 
if it is thought wise, by wet cups over the engorged lung. 

The depressant treatment of croupous pneumonia is, however, lim- 
ited in its application to the very beginning of the malady and to those 
persons who have a bounding circulation. It is absolutely contraindi- 
cated after consolidation has taken place or if the patient is feeble. 
Because of the fact that its usefulness is confined to this early stage, it 
cannot be employed in many cases, because the physician is not called 
till after this stage has passed by. I repeat, that its use in a case 
with a feeble pulse or in one who is adynamic or feeble is absolutely 
contraindicated. 

In the majority of cases the physician is called after the consolida- 
tion has occurred, and he must now be a watchman all the time and a 
therapeutist only when treatment is actually needed. Every man who 
is suffering from pneumonia does not need active treatment. A cer- 
tain number of cases get well without treatment, and do so sooner than 
if meddlesome therapeutics hinders them. The treatment usually neces- 
sary is to combat fever if it becomes excessive, to support the heart if 
it seems feeble or engorged, to keep the kidneys in a state of active 
secretion, and to see that constipation is relieved. 

In the treatment of the fever the physician should remember that it 
is not to be regarded as a dangerous symptom unless it rises to 103° and 
remains at this point for some hours, for in a febrile disease running a 
short course fever is not only not harmful, but there is reason to believe 
that when present to a moderate degree it is actually beneficial. 1 When 
the fever does rise to a point above 103° it should be reduced by spong- 
ing with cold water, active friction being used at the same time. (See 
Part III., on Cold.) There is absolutely no danger of the patient 
" taking more cold," although this is generally doubted by the laity. If 
the fever has a tendency to be excessive and if the heart's action is 
tumultuous an ice-bag may be placed over the heart, and this will be 
particularly useful if, as is often the case, there is a tendency to pericar- 
ditis. If it is desired to apply cold over a greater area of the chest 
than the prsecordium an ice-jacket may be employed, but it possesses 
the disadvantage of being a wet application, do what we will to protect 
the bedding. This ice-jacket is to be made of cracked ice and sawdust 
mixed and sewed up tight in an oil-silk covering which is basted to an 
undershirt to keep its shape. This treatment has been said to greatly 
reduce the inflammatory process in the lung, but of this there are 
grave doubts. 

The use of antipyretic drugs is not good practice. They tend to 
depress the heart, to relax the blood-vessels, and apparently render the 
patient more susceptible to his infection. Sponging, if it is properly 
employed, will generally control the fever. The cold plunge bath is 
usually badly borne in croupous pneumonia. (See Cold, in Part III.) 

For the support of the heart we may employ several circulatory 
stimulants. If the patient is a feeble case with a lack of vitality 

1 Sec article on "The Role of Fever in the Modification of Disease," in the Thera- 
piniir Gazette for February, L896. 



PNEUMONIA. 717 

and relaxation of his muscles, then alcohol in the form of a good 
whiskey or brandy given in water after food every three or four hours 
in the dose of from half an ounce to an ounce is useful. Sometimes 
more than this must be given, particularly if the patient has been 
accustomed to the use of the drug. In other cases less is needed. For 
the laboring heart with almost empty arteries no drug compares with 
digitalis, and if the skin is moist or the blood-vessels relaxed, so that 
the pulse is gaseous, then belladonna should be combined with it. The 
writer usually gives 5 minims (0.3) of the tincture of digitalis every eight 
hours, with 5 minims (0.3) of the tincture of belladonna every four hours. 
(See Digitalis and Belladonna.) If necessary, both of these drugs may 
be given in larger dose, but usually these doses are sufficient. If the 
fever is very high the digitalis will have to be supplanted by the alco- 
holic stimulants or strychnine for a few doses. The question as to 
whether the patient's pulse is of the proper strength is one of import- 
ance : very often the quiet pulse of a patient lying in bed will be taken 
by the inexperienced as an evidence of true cardiac feebleness, when 
if the physician feels his own pulse he will be surprised to find it no 
stronger than that of his patient. A feeble apex beat, a feeble second 
sound at the second right costal cartilage (aortic valve) and an accen- 
tuated second sound at the second left costal cartilage (pulmonary valve) 
will reveal the fact that active stimulation is needed, for the weak apex 
beat and the soft second (aortic) sound, show that the heart is feeble 
and the arterial walls relaxed, and this means a low arterial pressure. 
Further, the accentuated second sound on the right side indicates pul- 
monary congestion and a tendency to failure of the right side of the 
heart from obstruction to the flow of blood in the lungs. 

Should the action of the heart become labored, the jugular veins 
distended and pulsating, and the radial pulse weak, while the face is 
cyanotic, then free venesection (Part III.) is to be practised. It will 
often save an apparently desperate case. Digitalis in the presence of 
this condition is not rapid enough in its effects. Strychnine should be 
given in full dose hypodermically, yq-j-q of a grain (0.003-0.006), 
and with it, if the skin is moist or sweating, yj q- of a grain of atropine 
(0.0004), and both these drugs should be repeated in an hour if 
needed. At the same time it is well to give J drachm (2.0) of aro- 
matic spirit of ammonia every two hours in cold water or 1 drachm 
(4.0) of Hoffmann's anodyne in cold water every hour. 'Oxygen in- 
halations may be used at this time with benefit, particularly if cyanosis 
is marked. (See Oxygen.) 

If the patient be one advanced in years, with thickened arteries 
and a high arterial tension which causes the heart's action to be 
labored, nitroglycerin is to be employed. 

Should crisis come on at this time, active supportant treatment, such 
as that just described, will be needed. Many patients die in crisis for 
the want of active stimulation. 

Nervous excitement with insomnia, if excessive, may be combated 
by small doses, J- to \ grain (0.008-0.016), of morphine, given in the 
early evening by hypodermic injection. 

The secretion of the kidneys is best maintained by the use of some 



718 DISEASES. 

alkaline diuretic, such as sweet spirit of nitre and citrate of potassium, 
and if necessary a little gin may be given to support the heart and aid 
in maintaining renal activity. 

Having detailed this treatment of the second stage, that for the 
third stage is to be considered. For the thorough understanding of 
this we should remember that this stage consists in the breaking down 
or resolution of the exudations and in their absorption and expulsion 
from the chest. 

At this time the entire diseased area is crowded with secretions 
which have been formed, dead epithelial cells, and all the morbid sub- 
stances which have accumulated. The local surfaces are depressed by 
the reaction following upon the excitement of inflammation, and their 
tone is below par. The object of the physician must be to stimulate 
these areas so that they may throw off the old and take on a new 
functional activity, and for this purpose remedies are to be used which 
will soften deposits and stimulate depressed vesicles and bronchial 
tubes. 

By far the most valuable class of drugs to be here employed are 
those which will increase the secretion from mucous membranes without 
acting as cardiac depressants. Under the article on Bronchitis the 
action of these drugs will be found more thoroughly explained, but it 
will suffice to point out, at this time, the method of their administra- 
tion. 

First and foremost for the relief of any associated bronchitis stands 
the chloride of ammonium, a drug whose elimination takes place largely 
through the lungs, and which acts most happily in aiding in the loosen- 
ing of the cough and secretions. Its only disadvantage is its salty 
taste, which in many cases renders it disagreeable to the patient, 
while its irritant properties may disorder the action of the stomach, 
although if this organ is depressed and atonic this drug often improves 
its condition. This drug may be given in compressed pills, or, what 
is far better, in such a mixture as here follows : 

R.— Ammonii chloridi Sj.j (8.0). 

Extract, glycvrrhizse fl £ij (8.0). 

Aquae dest. . * fgiij (90.0).— M. 

S. — Teaspoonful (4.0) in water every four hours during the day. 

If the cough be in excess of the expectoration — that is, if the 
cough often fails to bring up phlegm and is due to tickling or irrita- 
tion-it may be relieved by the addition of a little morphine to this 
mixture, as follows : 

R. — Morphinae sulph gr.j vel gr. ij (0.05-0.1). 

Ammonii chloridi 3'j (8.0). 

Extract, glycyrrhizae fl ^iv (1G.0). 

Aquaedest. Ev (180.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

If much more morphine than this is used, it will tend to stop 
secretion. 



PRURITUS. 719 

When the chloride of ammonium fails to act favorably, the car- 
bonate maybe called into use for its local and circulatory action, and, 
in addition, the bromide of ammonium may be employed to allay the 
cough if morphine cannot be used. The following prescription is 
valuable : 

R. — Ammonii chloridi 3J (4.0). 

Ammonii bromidi gj (4.0). 

Ammonii carbonat ^j (4.0). 

Extract, glvcyrrhizae fl ^iij (12.0). 

Aquae dest." fgvj (180.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

In other cases heroin may be given in the dose of y 1 ^- grain every 
eight hours to control excessive cough. 

(For other remedies for this stage see Bronchitis.) 

It must be borne in mind that the effect of expectorant drugs upon 
the pneumonic process itself is very slight and that they are not to be 
given unless free bronchial secretion is present. 

Nutritious broths, milk, and, if necessary, predigested foods, should 
be given with the regularity with which medicine would be given from 
the beginning to the end of the attack. 

Catarrhal Pneumonia. 

The main difference in the treatment of Catarrhal Pneumonia in 
distinction from the treatment of croupous pneumonia lies in the fact 
that first, last, and all the time the treatment is to be stimulant in its 
character if any treatment other than rest in bed is resorted to. 
Catarrhal pneumonia usually arises out of an acute bronchitis or is 
superimposed upon some exhausting disease which has sapped the 
vitality. Toward its close expectorants are even more useful than in 
croupous pneumonia, and every care should be taken that the catarrhal 
process does not pass by insidious degrees into a hidden tuberculosis. 
All cases in which recovery is abnormally slow should be suspected of 
tubercular infection. 



PRURITUS. 

Itching of the skin or mucous membranes about the openings of 
the body is a very common state, and while it may be dependent upon 
local causes, such as lice or fleas, it more commonly is due to some 
systemic condition, such as debility, diabetes, gout, or renal disease, 
or other similar causes. The treatment consists, first, in the removal 
of the cause, and, next, in the local treatment of the condition. There 
is generally no redness or eruption, except that due to scratching. 

Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline 
diuretics, or mineral waters are useful in debilitated cases, and an 
avoidance of condiments, such as mustard or pepper, is needful if the 
disease affects the mouth of the urethra or vagina. 



720 DISEASES. 

The local treatment of pruritus consists in the use of lotions, salves, 
or ointments made up of various constituents, a number of which are 
capable of acting as local anaesthetics. Very often, bathing the 
parts with 1 drachm of bicarbonate of sodium or of borax to a pint 
of cold water gives relief temporarily, or the following formulae will 
be of service : 



R.— Acidicarbolici f%j vel f£ij (4.0-8.0). 

Aquae dest q. s. ad Oj (500 cc.) — M. 

S. — Apply as a lotion several times a day. 

Or, 

R. — Liquor. carbon, detergen. 1 .... f^ij (8.0). 

Aquse q. s. ad Oj (500 cc.). — M. 

S. — Apply as a lotion. 

Or an ointment made as follows is serviceable : 

R.— Acidi carbolici gtt. v vel xx (0.3-1.3). 

Adipis benzoinatus §j (32.0). 

Petrolati £j (4.0).— M. 

S. — Apply as an ointment. 

In other cases 10 to 20 minims (0.65-1.3) of chloroform may be 
used in place of the carbolic acid. 

Cocaine may be painted over the parts, but it should rarely be 
used in ointment, as fats prevent its acting effectively. It should 
also be remembered that the anal and vaginal mucous membranes are 
so thick that strong solutions of cocaine are necessary to produce 
anaesthesia, and that the effects of cocaine are only temporary. 
Cocaine is useless when applied to the skin. Where the itching is 
very obstinate the parts may be painted with a solution of nitrate of 
silver of the strength of 20 grains to the ounce (1.3 : 30.0) of water, 
cocaine having been previously applied to relieve the pain of the appli- 
cation. (See article on Cold.) Brinton has highly recommended 
powdered teucrium scordium in the dose of 20 grains (1.3) three times 
a day for itching hemorrhoids. 

Allingham has used with advantage a piece of ivory shaped like a 
rubber nipple and provided with a circular shield. This is slipped 
into the bowel at night and serves to keep the surfaces apart. 

In cases of general pruritus baths are often of great service. They 
may consist in plain hot-water baths or Turkish baths. In other 
instances, to each bath of 30 gallons may be added \ pound of bicarbo- 
nate of sodium, or 1 to 4 ounces (30.0-120.0) of borax may be used. 
When the skin is very irritated starch, 1 pound (500.0), or bran, 2 
pounds (1000.0), may be added to the bath. Sometimes linseed-meal 
baths may be used. The meal is placed in hot water until the gluti- 
nous matter is set free, when it is added to the bath. One or two 
pounds (500.0-1000.0) are used. In very persistent cases the patient 
may actually eat and sleep in the bath with advantage. 

1 For method of preparing this liquor see article on Eczema. 






PUERPERAL DISEASES. 721 



PUERPERAL DISEASES. 



The diseases of the puerperium may be divided into two broad 
classes — infectious and non-infectious. The first class should be 
further subdivided into (1) those infectious diseases in which the 
point of infection has been somewhere along the parturient tract, 
and (2) those in which the infecting poison has entered the body bv 
some other channel. Under sub-heading 1 come all those diseased 
conditions grouped together under the very inadequate generic terms 
"puerperal fever," "puerperal septicaemia," "puerperal infection," 
and the like, none of which truly express the condition. If it is 
necessary in medical nomenclature to have a single term which 
shall denote infection of the genitalia after delivery, a word should 
be coined strictly limited in sense to mean the pathological conditions 
which result from the activity of pathogenic microbes along the whole 
genital tract. This classification is necessary for a clear and sys- 
tematic description of the treatment of diseases in the puerperal 
state. 

The Treatment of Infection along the Genital Tract after Labor. — 
The most common form of infection along the genital tract after labor 
is a toxaemia from the infection and decomposition of membranes, frag- 
ments of placenta, or blood within the uterus. Therefore, in any case 
after labor in which there is fever that cannot be explained by some 
evident cause independent of the genitalia, it is safe to assume that the 
uterine cavity is the seat of pathogenic micro-organisms, and act 
accordingly. The indications are plain : to destroy the microbes, 
and thus at once stop the manufacture of their poisonous products, 
and, if necessary, to remove their habitat. 

The writer's routine application of this principle in practice is as 
follows : If the temperature after delivery remains over 100° F. for 
twenty-four hours without evident cause independent of the genitalia, 
he washes out the uterine cavity with at least 1 quart (1 litre) either 
of bichloride-of-mercury solution, 1 : 2000, or a 2 per cent, solution 
of creolin. The former is more convenient in private practice, be- 
cause the tablets of corrosive sublimate can be easily carried about in 
one's instrument-bag. To ensure the entrance of the antiseptic fluid 
to the fundus and its free exit from the cervical canal an intra-uterine 
catheter is desirable. Of all those upon the market, the best is that 
known as Fritsch's modification of Bozeman's catheter. If, how- 
ever, the cervical canal is patulous, as it usually is after labor, a 
hard-rubber catheter attached to a Davidson's or fountain syringe 
answers the purpose perfectly. 

In many cases this treatment brings the temperature down to nor- 
mal within twenty-four hours. If fever does not disappear within this 
time or perhaps rises even higher, the second indication must be met. 
The infected albuminous substance within the uterine cavity must be 
removed in order to deprive the micro-organisms of their feeding-ground. 
This is best accomplished by the use of the curette and the placental 
forceps, care being taken in the employment of the former instrument 
to guard the uterine wall itself from the slightest injury ; for not only 

46 



722 DISEASES. 

can the uterine muscle be perforated by a curette in clumsy hands, but 
slight wounds of the uterine substance with this instrument may be 
enough to inoculate the general system with the germs whose activity 
has been before confined to the uterine cavity. 

The writer's manner of employing this plan of treatment after 
labor is as follows : 

The anterior lip of the cervix is seized with a double tenaculum 
and pulled gently downward ; a cleansing uterine douche is then 
given in order to disinfect the field of operation; next the curette is 
inserted to the fundus, and the whole interior of the uterus is carefully 
gone over with the* instrument, first the fundus and then each of the 
four sides ; then the curette is turned with the scraping surface upward 
and withdrawn from the cervical canal, a finger in the vagina meet- 
ing its tip as it emerges in order to help extract any substances which 
may be caught by and entangled in it. 

Next the placental forceps is inserted, and an effort made Co grasp 
any material lying loose within the cavity or still attached to the 
uterine walls. It is usually best to repeat each of these manoeuvres 
several times until nothing more can be brought away except a little 
clear blood. 

Then the uterine cavity is again thoroughly washed out. Occa- 
sionally it is necessary to repeat the irrigation, but rarely the curet- 
ting, for several successive days. If this treatment should prove 
unsuccessful and the temperature should remain elevated in spite of 
irrigation and the use of the curette and placental forceps, one must 
assume either that general systemic infection has occurred, or at. least 
that an inflammatory action has begun in the uterine walls or within 
the tubes. One of the signs of systemic invasion is the appearance 
of peritonitis. 

In such a case the only treatment is to support the body-cells in 
the combat which thev must wage with the invading micro-organ- 
isms. This is best accomplished by the administration of as large a 
quantity of nutriment as the patient can stand without rebellion of 
the stomach or bowels, and the exhibition of a large quantity of 
alcoholic stimulant. Cases of this sort not infrequently require more 
than a pint of whiskey or brandy in the twenty-four hours. Occa- 
sionally measures are required to reduce an exaggerated elevation of 
the temperature, but this is best avoided as long as possible, for anti- 
pyretic treatment is usually depressing and ill suited to the patient's 
adynamic condition. 

The use of antistreptococcic serum, nuclein, and injections of nor- 
mal salt solution are important adjuvants to the treatment which 
should not be neglected in a serious case. With this plan of treat- 
ment about three-fourths of the cases of general septic infection 
after labor will recover. There may be some in which metastasis 
to important organs occurs so early as to render all treatment of no 
avail. There will be others in which the peritoneum is early infected, 
mid in which the septic peritonitis develops rapidly and to an exten- 
sive degree. Tt is in such cases that cceliotomy and evacuation of the 
septic matter, usually pus, within the peritoneum will occasionally save 






PUERPERAL DISEASES. 723 



life. The physician must guard himself, however, from operating 
too early and unnecessarily. After operation, drainage of the peri- 
toneal cavity is an essential feature of the treatment, even although 
the evidence of suppuration within the cavity is slight. The writer 
has in mind a case in which an operation was performed ten days 
post-partum for septic peritonitis : a very small quantity of purulent 
lymph was found upon one ovary, which was greatly enlarged and 
contained a small quantity of sero-pus. The ovary was removed and 
the abdomen closed without drainage, as there was no other evidence 
of suppuration within it. Thirty-six hours later the patient died, 
and the peritoneal cavity was found filled with pus which had accu- 
mulated in that short space of time. In the early stages of the 
peritoneal infection, if the subject is vigorous, not exhausted by a 
prolonged labor or other depressing causes, the administration of saline 
purgatives in concentrated solution often effects brilliant results. 

The writer's custom is to give a dessertspoonful of a concentrated 
solution of Epsom salts every fifteen minutes until free evacuation of 
the bowels is secured. He has seen the temperature reduced by this 
plan of treatment from 104° F. to normal in the course of twelve 
hours, and with the reduction of temperature all the symptoms of 
peritonitis, which were well marked, entirely disappeared. 

In the treatment of microbic activity along the parturient tract after 
labor it should never be forgotten that the point by which the microbes 
invade the system may be anyAvhere from the fundus of the uterus to 
the parturient outlet ; therefore the practitioner should never neglect 
to examine carefully all the lower parturient tract, in order to detect, if 
possible, an ulcerated surface covered by diphtheritic membrane, which 
if overlooked might be the entrance-point for a fatal infection. These 
unhealthy surfaces are best detected by the use of a cylindrical speculum 
of clouded glass introduced so that the cervix appears within its inner 
end, and then withdrawn, so that the vaginal mucous membrane as it 
prolapses into the end of the speculum may be examined, and treated 
if necessary throughout its whole extent. If an unhealthy, ulcerated 
wound is thus discovered, the writer's practice is to apply to it a solu- 
tion of nitrate of silver 40 or 60 grains to the ounce (2.65 : 30.0). 
In the vast majority of cases this application will promote an exfolia- 
tion of the unhealthy membrane and the appearance of healthy gran- 
ulation tissue within a few days. 

It may, in some cases, be necessary to employ a stronger applica- 
tion, as the solution of chloride of zinc, but the writer has not been 
driven to its use. The most common point of infection outside the 
parturient tract after labor is some portion of the urinary apparatus, 
almost invariably the bladder. The process of parturition necessarily 
diminishes the vitality of the vesical mucous membrane cells by the 
pressure and stretching to which they are subjected. After labor, 
therefore, they are not in a condition to resist the attacks of micro- 
organisms should these in any way gain access to the vesical cavity. 
Most commonly microbes are introduced into the bladder by a cath- 
eter. This, however, is not necessary, as it has been plainly demon- 
strated that they can wander from the vaginal canal through the 



724 DISEASES. 

urethra into the bladder without the intervention of an instrument 
which would directly carry them into the vesical cavity and deposit 
them in that situation. Once arrived within the bladder, the microbes 
attack the depressed bladder-cells, and very often gain a lodgment 
in the vesical mucous membrane. This is manifested by the usual 
symptoms of septic cystitis — fever, pus in the urine, pain on pressure 
over the hypogastrium, and pain and difficulty in micturition. The 
duration of these symptoms is, as a rule, not very long. The fever 
subsides and the symptoms of cystitis disappear. After an interval 
of some days, however, there is again a sharp outbreak of fever, with 
pain in the region of the kidneys and the reappearance of pus, or at 
least of numerous microbes, in the urine. This indicates a septic 
infection of the pelves of the kidneys after the micro-organisms have 
migrated along the ureters. During their migration their presence 
has not been manifested by any symptoms. In the majority of cases 
even the symptoms of pyelitis will disappear after a time, and the 
patient will make a good recovery ; but in a certain proportion there 
is a systemic infection by the direct passage of microbes or their 
products from the kidneys into the blood. There may be an extensive 
suppuration of the kidneys and surrounding tissue, with fatal results, 
or, as the writer has seen in several cases, the symptoms of general 
systemic infection become so grave as for a long time to threaten the 
patient's life. In the worse cases of bladder infection the mucous 
lining sloughs, peritonitis develops, and the patient dies before the 
disease has time to spread to the kidneys. 

The practitioner, bearing in mind the serious consequences of sep- 
tic cystitis after labor, should always be on the watch for it, and 
should adopt an energetic treatment immediately upon its discovery. 
A thorough disinfection of the bladder will remove all present symp- 
toms, and prevent the occurrence of grave and possibly fatal after- 
complications. To accomplish this purpose the writer employs a satu- 
rated solution of boracic acid. One injection of a quart of this solution 
through a two-way catheter is usually sufficient. Occasionally it is 
necessary to repeat it or to follow it by several injections of boric-acid 
solution. A 1 : 8000 bichloride-of-mercury solution may be employed 
if the first boracic acid solution fails to improve the local symptoms. 

If, in spite of all precautions, infection of the kidneys should 
ensue, a vigorously stimulating and supportive plan of treatment 
affords the only hope of success. If extensive suppuration occurs in 
the kidneys, all treatment will of course be useless. 

Perhaps the most uncommon point of septic infection after labor 
is the rectum. The writer has, however, seen one fatal case of this 
sort — from the use, no doubt, of a dirty syringe-nozzle in the hands 
of a careless nurse. It would be difficult, or perhaps impossible, to 
diagnosticate such a case until after death, and therefore treatment 
directed toward this form of infection will usually not be adopted. 

Next in frequency to the parturient tract and the urinary system 
as a region of infection after labor come the breasts. Infection of the 
nipples, and a consequent mammary inflammation or suppuration, is 
one of the most troublesome minor complications that the obstetrician 






PUERPERAL DISEASES. 725 

is called upon to treat. By careful preparation of the nipple during 
the last month of pregnancy, and by extreme care to secure perfect 
cleanliness during the period of lactation, infection of the breasts can 
almost surely be avoided. If it occurs, the first effort should be to 
limit its extent and degree, and to prevent, if possible, suppuration. 
The best means to accomplish this end are derivation of the blood 
from the mammary glands by an active purge, compression of the 
gland-substance, and support of the breasts by a suitable mammary 
binder. 

To these should be added, in the acute stage of inflammation, 
fomentations of very hot water, and, later, the application of cloths 
wrung out in lead-water and laudanum, renewed every three hours. 
Unless the infection has been of a virulent nature and the amount 
of infective material large, this plan of treatment will almost surely 
dissipate the inflammation and prevent suppuration. 

The other infectious fevers of the puerperal state include the in- 
fectious diseases which can, under any circumstances, attack the adult 
female, and their treatment differs in no respect during the puer- 
perium from that adopted under ordinary circumstances, unless there 
should be developed some local complications. 

Non-infectious Diseases of the Puerperium. 

Anomalies of Involution. — Superinvolution, an exaggeration of 
that process by which the uterus is reduced to its normal size after 
labor, only manifests itself, as a rule, after the puerperal state is com- 
pleted, and therefore its treatment need not be further considered. 

Subinvolution, an arrested or retarded return of the uterus to its 
normal condition and dimensions after labor, is one of the commonest 
complications with which the obstetrician has to deal in the manage- 
ment of the puerperium. The cause of subinvolution is always a 
local one. General conditions, as acute fevers and so on, have no 
influence whatever upon the process of involution unless they are 
accompanied by some local complication. 

There are two causes which prevent the involution of the uterus 
which must be borne in mind when one is called upon to treat this 
condition. The involution may be prevented, on the one hand, by 
anything which calls an excessive amount of blood to the uterine 
body, as, for instance, small fibroids within its walls or hypertrophied 
deciduous membrane remaining adherent to its inner surface. On 
the other hand, subinvolution may be the result of mechanical obstruc- 
tion to the contraction of the uterine walls and the reduction of the 
cavity of the uterus to the normal size. As an example of this we 
have a retained placenta or a submucous fibroid or adhesions dragging 
the uterus out of place and preventing its contraction, or, most com- 
monly perhaps, an over-distended bladder and rectum. 

In those conditions which result in a hyperemia of the uterus the 
cause of an excessive blood-supply must be sought out and removed 
before one can remedy the subinvolution. 

If small fibroids can be detected, the administration of quinine, 



726 DISEASES. 

ergot, and strychnine in pill form has been found most useful. If 
practical, a faradic current may be employed in addition to medica- 
tion. If there is an hypertrophied endometrium retained within the 
uterus, a curette will most quickly and effectually hasten involution. 
In cases of heart disease in which the blood-current is sluggish and 
dammed back into the large veins of the trunk digitalis will be the 
most effective remedy to overcome the subinvolution. There may be 
an active hypersemia associated with inflammatory action, either in 
the uterine wall or upon its peritoneal covering or in its annexa; in 
this case the inflammation must be overcome by disinfection, the use 
of purgatives, and, possibly, the local application of hot water, before 
involution can be secured. When there is mechanical obstruction to 
the return of the womb to its normal dimensions, the hindrance must 
of course be removed before one can expect a good result from treat- 
ment. In the case of retained adherent placenta every effort must 
be made to remove the placental tissue. In the case of submucous 
fibroids their removal must be attempted if there is any hope of safely 
accomplishing it. 

There is no case of labor which does not leave behind, in the par- 
turient tract, some injury to the maternal structures. Usually these 
are slight in degree, manifesting no symptoms and healing spontane- 
ously. Occasionally the injury done results in fistula communicating 
with the bladder or rectum, in deep granulating wounds in the vagina, 
or in ulcerated sores. 

In the case of fistula a cure can sometimes be effected without 
operative interference by touching up the edges of the fistulous tract 
with nitric acid, in order to excite an outpouring of granulation tissue 
in the hope that it may plug up the opening. In deep tears, which 
have not been primarily united, application of a solution of nitrate 
of silver will hasten the cure and prevent infection of the wounded 
surface. If ulceration occurs, the ulcerated spots are to be carefully 
watched and treated in the same manner. 

Hemorrhages from the birth-canal after labor depend upon a num- 
ber of well-known causes, which must be sought out and corrected 
before the bleeding will cease. Most frequently the cause of a hem- 
orrhage will be found in retained placental fragments in utero, which 
must be removed. Frequently displacements of the uterus will be found 
as a cause, and correction of the displacement will stop the bleeding. 

In interstitial bleeding after labor, resulting in hematoma, care 
must be taken to preserve the parts in as aseptic a condition as pos- 
sible, while an attempt is made to limit the bleeding by the applica- 
tion of direct cold, preferably by means of a Barnes bag dilated with 
ice-water, which must be removed from time to time in order to allow 
the lochia to escape. After rupture or incision of these blood-tumors 
the cavity left behind must be carefully disinfected with the bichlo- 
ride-of-mercury solution, and, if necessary to control further bleeding, 
well ] tacked with iodoform gauze. 

Of all forms of bleeding, that which occurs directly after labor in 
consequence of inertia uteri, known as post-partum hemorrhage, is 
the most frequent, the most alarming and dangerous in its manifesta- 



PUERPERAL DISEASES. 727 

tions and consequences. No one should attend a case of obstetrics 
without having in mind a clearly-defined programme to be put in 
immediate execution when called upon to deal with this frequent and 
dangerous complication. There are two indications to be met : First, 
to control the hemorrhage, and, second, to treat the after-condition. 
The first indication is met by the following plan of treatment : 

External stimulation of the uterus by kneading and rubbing 
through abdominal walls, as is practised in Crede's method of 
expressing the placenta. 

Next carry the other hand into the uterus and remove any blood- 
clots, pieces of placenta, or membrane that may be found there, so 
that the internal surface of the uterine walls is irritated by the move- 
ments of the operator's fingers. 

Next apply a small piece of ice upon the abdomen externally, and 
carry another piece the size of a hen's egg into the uterine cavity. 
The use of cold must not be persisted in for more than a minute at 
most, for its ultimate action is depressing and relaxing. 

Next soak a clean linen handkerchief in vinegar, carry it up to 
the fundus, and squeeze it out so that the vinegar shall run down 
over the uterine surface. 

Next, hot water at a temperature of 116° or 120° F. should be 
injected into the uterine cavity. 

If one happens to have the necessary appliances at hand (a small 
Gaiffe battery, which can be carried in an ordinary instrument-bag), 
a strong faradic current can be applied to the uterine muscle. 

Finally, as a last resort, the uterine cavity may be packed with long 
strips of iodoform gauze in the manner suggested by Duhrssen and 
carried out by a number of observers with gratifying success. 

Drugs, as the styptic salts of iron, and especially Monsel's solu- 
tion, have been recommended from time to time as intra-uterine appli- 
cations in the case of post-partum hemorrhage, but they are dangerous, 
for the coagulation produced by them may extend far into the uterine 
vessels, and the clots must be broken up by putrefaction, exposing the 
patient to the danger of septic poisoning. 

This programme is to be carried out in the order given : if the 
milder measures suffice, of course the more radical plans of treatment 
will not be employed. Excessive hemorrhage (post-partum) from 
lacerations along the genital canal can be controlled by well-placed 
sutures. 

Bearing in mind this plan of treatment, it is almost inconceivable 
that an intelligent and skilful practitioner should lose a case of post- 
partum hemorrhage. 

The physician should give ergot in full dose by the mouth and, if 
need be, hypodermically. 

Treatment of the After-condition. — While the physician is busy 
controlling the hemorrhage the nurse should administer a hypodermic 
injection of ether if symptoms of shock or collapse are manifested. 
After the bleeding has ceased it is well to administer an enema of a 
pint of hot water, which maintains the patient's temperature, relieves 
the shock, and by its irritation promotes contraction of the uterine 



728 DISEASES. 

muscle. This should be succeeded by small doses of hot, strong 
brandy-and-water, and a little warm milk if the stomach will retain 
it. As soon as reaction is well established a half-pint (250 cc.) of 
hot beef-tea should be administered, and a hypodermic of -J- grain 
(0.008) of morphine given in order to secure quiet and rest and to 
get the stimulant qualities which this drug undoubtedly possesses. 
Occasionally measures must be adopted to retain enough blood within 
the large vessels and in the heart to prevent excessive cerebral anaemia 
or cardiac failure. This is best done by auto-transfusion ; that is, by 
bandaging the extremities from below upward, in order to secure as 
large a quantity of blood as possible within the vessels of the trunk 
and brain. Actual transfusion of a T 6 ^-of-l-per-cent. solution of com- 
mon salt into the blood-vessels is required when there are profound 
exhaustion and depression after hemorrhage. It has been demon- 
strated that it is not necessary to throw this solution directly into the 
blood-vessels, as interstitial injection seems to answer the purpose 
equally well. The most convenient place for such injections in females 
is under the breasts. (See Hypodermoclysis, Part III.) 

The milk secretion during the puerperal state presents abnormal- 
ities which call for treatment. One may have to deal with anomalies 
of quantity or quality. The most frequent anomaly of quantity in 
milk secretion is unfortunately one of deficiency. Insufficient milk- 
supply depends on a number of causes. Perhaps the most frequent is a 
lack of development of the glandular tissue, and in this form of 
insufficient milk secretion no treatment can be of avail. When the 
lack of milk is due to some intercurrent affection in the puerperal 
state the treatment must be directed toward this complication before 
the milk-supply can be re-established in normal quantity. It may 
be the consequence of hemorrhages or of diarrhoea, or the result of 
an acute febrile attack during lactation, or of inflammation within 
the gland itself. Serious organic disease may also be a cause, and 
insufficient nourishment must be held accountable in some cases. 
Profound emotions exert an extraordinary influence upon lactation 
in altering both the quantity and the quality of the milk. It has 
long been supposed that the return of menstruation has a disastrous 
influence upon milk secretion. This, however, has been definitely 
disproved by careful observations recently conducted in Austria. 
The return of normal menstruation without complications has no 
apparent influence, as a rule, upon the quantity or quality of the 
woman's milk. In all the temporary diseases interfering with milk 
secretion described above it should be borne in mind that on the dis- 
appearance of the abnormal general or local condition milk secretion 
can be successfully re-established, even though it be absent for days 
or weeks. Electricity has been much vaunted of late as a remedy 
for insufficient lactation. It may be applicable in cases of torpidity 
of the mammary gland or in those cases where lactation has been 
suppressed on the birth of a first child, and where the mammary 
gland, therefore, does not respond readily to the stimulus of subse- 
quent births. This remedy will, however, often prove ineffective and 
disappointing. 



PUERPERAL DISEASES. 729 

Instances of excessive milk secretion are not infrequently met with. 
In the milder and simpler forms they can be managed by regulation 
of the diet and free purgation. Galactorrhea, a constant flow of 
milk from the breasts, is one of the most stubborn forms of excessive 
milk secretion. Two measures can usually be relied on to give relief: 
firm compression of the mammary gland with the application of bella- 
donna ointment, or the administration internally of iodide of potas- 
sium. In some cases of this character milk secretion stops sponta- 
neously with the return of menstruation, and in a certain proportion: 
of cases a treatment to secure a discharge of blood from the uterus 
has been successful in stopping the flow of milk. Success has been 
obtained with Simpson's plan of introducing a piece of caustic within 
the uterus in order to bring back the menstrual flow. Warm douches 
have been used successfully for this purpose. Electricity has been 
recommended to secure the proper contraction of the sphincter muscles 
of the lactiferous ducts, but as this is usually a result, and not a.cause, 
of the galactorrhea, the use of electricity must prove in the vast 
majority of cases ineffective. The long-continued administration of 
ergot has been warmly recommended. The remedy should be tried, 
for its use seems rational. Chloral has been shown to be very effective 
in diminishing the quantity of milk. This drug, therefore, is worthy 
of trial. It has recently been declared that antipyrine, in 2J-grain 
(0.12) doses three times a day, will diminish milk secretion. The 
drug, however, has not been tested often enough to demonstrate its 
power. Quantitative anomalies in the milk secretion must often 
depend upon an ill-regulated diet. A fatty diet will diminish the 
quantity of milk ; a vegetable diet will diminish the casein, and fat 
will increase the sugar ; a diet rich in meat, especially if reinforced 
with alcoholic stimulants, will increase the fat and casein, but will 
diminish the sugar. If the mother's milk is evidently disagreeing 
with the nursing infant, a chemical analysis of it should be made, and 
on the result rules regulating the diet should be adopted. The most 
common mistake in practice is to over-feed a nursing woman, espe- 
cially with a milk diet, with the idea which prevails extensively among 
the laity that the cow's milk poured into the stomach appears again 
in the mammary gland. It is usually sufficient for a nursing woman 
to observe the ordinary diet which agrees with her under all circum- 
stances, with the addition perhaps of a half-pint of milk midway 
between the morning and mid-day and mid-day and evening meals. 
Occasionally a wineglassful of malt at the mid-day and evening meals 
is a useful addition to the diet, and in anaemic patients the addition 
to the malt of 5 grains (0.3) of pyrophosphate of iron will be an 
advantage. 

There is found in every pregnant woman some alteration in the 
constitution of the blood, which consists, roughly speaking, of a dimi- 
nution of the red blood-corpuscles and of the albumin and the iron 
in the blood, with an increase in the white blood-corpuscles and the 
watery element. In some cases this change is much exaggerated, 
until an intense degree of anaemia appears in the puerperal state 
which, in its severity, will simulate pernicious anaemia or some fatal 



730 DISEASES. 

form of blood disease. The anaemia of puerperal women, however, 
even in exaggerated cases, usually yields to treatment in a most 
gratifying manner. After the prolonged use of Blaud's pills the 
writer has seen the blood-corpuscles rise from less than three to 
nearly four and a half millions, and the haemoglobin increase from 
40 to 75 per cent, in a few weeks. In some cases arsenic alone suc- 
ceeds where iron fails completely. 

Eclampsia. 

To treat eclampsia intelligently and successfully it is necessary to 
understand its etiology as fully as modern knowledge permits. Al- 
though the subject needs more light from future investigations, enough 
is now known to justify the following statement: 

1. The cell-activity of mother and foetus produces excrementitious 
substances which are poisonous to the w r hole organism unless they are 
voided or made harmless by the excretory organs. 1 

2. The organs in the childbearing woman are often inadequate to 
the disposal of effete material from the maternal and foetal bodies. 

3. Consequently, poisons, of a nature not yet demonstrated, are 
stored up in the maternal blood until, by cumulative action, their 
presence is manifested in the eclamptic seizure and other symptoms. 

4. The convulsions are probably the result of an acute cerebral 
anaemia brought about by violent contraction of the arterioles, possibly 
by direct irritation of the brain-substance or perhaps by the emboli of 
giant cells from the placenta, described by Echinard. As a result of 
intense muscular action the circulation is interfered with, and blood is 
determined into non-muscular regions, as the brain, lungs, kidneys, 
etc., to such a degree that the congestion of these parts becomes dan- 
gerous, leading to apoplexy in the brain, oedema in the lungs, and 
often a complete abrogation of renal function. 

The indications for treatment in convulsive seizures of this nature 
are plain : 

First, to eliminate the poisons from the blood as quickly and in as 
large quantities as possible. Second, to diminish nervous sensibility 
and lessen muscular power, in order to reduce the convulsions in 
vehemence, duration, and frequency. Third, if convulsions occur 
during labor, to save the infant without adding to the risk of the 
mother. Fourth, to guard the woman from injury during the attack. 

The first indication is met by venesection, diaphoresis, and cathar- 
sis. By the first, one eliminates a certain quantity of poison along 
with the blood and relaxes the muscles. If there is sharp post- 
partum hemorrhage, or if the patient is from any cause weak and 
anaemic, bloodletting is not called for. In the ordinary case, how- 
ever, with full pulse, congested head, the veins standing out upon the 
neck and face, venesection is an undoubted advantage. While the 
median basilic of one or both arms is being opened some croton oil 
should be sent for, and 2 minims (0.1) mixed with sweet oil may he 
placed upon the tongue. Directions should at the same time be given 

' II;in»ld ( '. Krnst, American System of Obstetrics, vol. ii. p. 431. 



REMITTENT FEVER 731 

to wring out three or, better, four old blankets in boiling water; these 
are to be wrapped around the legs, trunk, and arms, and well covered 
over with one or more dry blankets. A hot-air bath, or immersion of 
the patient's body in a bathtub full of hot water, is equally efficient. 
A submammary injection of a pint of normal salt solution is an extremely 
valuable aid in producing free diaphoresis. The sweating thus induced 
is profuse. An ice-bag must be put to the head to prevent over-con- 
gestion of the brain. In this way one eliminates the cause of eclamp- 
tic convulsions as quickly and thoroughly as possible from the blood, 
directly and indirectly through the skin and bowels. The latter may 
be acted upon by \ grain of elaterium rubbed up in butter, or by 
compound jalap powder and calomel, instead of resorting to the croton 
oil. Pilocarpine seemed at one time an ideal remedy to secure diaph- 
oresis in eclamptic cases, but it has lately fallen into well-deserved 
disrepute. It much increases the danger of pulmonary oedema, and 
is too profound a depressant. It is no longer employed by experienced 
and educated obstetricians. The second indication is best met by an 
anaesthetic. Usually the convulsion first shows its approach in the 
eyes : these should be closely watched, so that on the first symptom 
of the oncoming attack chloroform may be at once administered and 
pushed as rapidly as possible. Ether is inadmissible in these cases, 
for it is slow of action, congests the brain, and irritates the kidneys. 
Just before the woman is wrapped in blankets 1 drachm (4.0) each of 
chloral and bromide of potassium in starch-water should be injected 
into the rectum. This may be repeated in an hour if necessary. 
Morphine, veratrum viride, and inhalations of nitrite of amyl have 
their enthusiastic advocates in this connection. They may be held 
in reserve in case the plan of treatment described needs reinforce- 
ment. 

If convulsions come on during labor, the child should be rapidly 
extracted as soon as the os is well dilated, but not before, because 
efforts to dilate the os would be very apt to increase the convulsions, 
and would attract the physician's attention from the woman's most 
threatening danger. Moreover, the os dilates naturally with unusual 
rapidity during eclampsia. 

The only injury to be feared during eclamptic attacks is wounds 
of the tongue from the teeth. This can be prevented by inserting 
between the teeth a brush-handle wrapped in a handkerchief or by 
drawing a towel into the mouth like a bit. Well-meaning but igno- 
rant bystanders will sometimes throw themselves upon an eclamptic 
patient to restrain her convulsions by force. This should be forbidden. 

REMITTENT FEVER. 

This is sometimes called bilious fever by reason of the violent 
bilious vomiting and jaundice which often accompany it. It separates 
itself from intermittent fever *by the fact that the patient's condition, 
chiefly as regards temperature, does not have normal intervals, but 
has periods of only temporary improvements, or, in other words, the 
disease remits. Not only is this true, but it is to be remembered 



732 DISEASES. 

that the gestivo-autumnal parasite which produces remittent fever is 
more difficult to destroy than the tertian or quartan forms, and that 
larger doses of quinine are needed for this reason. 

For the proper treatment of this fever, three things must be borne 
in mind : 1. It is more dangerous than intermittent fever ; 2. It is 
dangerous in the hot stage, not in the cold stage ; 3. The patient, 
not having periods for complete or partial recovery, rapidly loses 
strength. The safety of the patient depends upon the use of large 
doses of quinine to cut short the pyrexial stage, the doses used being 
from 20 to 30 grains (1.3-2.0) a day or 5 grains (0.32) every four 
hours, preceded by a good-sized purgative dose of calomel, say 3 to 4 
grains (0.15-0.2). If vomiting is too violent to permit of the reten- 
tion of the quinine, it must be used by the rectum and hypodermi- 
cally, and the stomach and intestines be swept out by the use of 
divided doses of Seidlitz powder or citrate or sulphate of magnesium. 
If purgatives are used, they should precede the quinine by twenty 
minutes, as otherwise the latter drug is swept out in the bowels, where 
it is rendered useless by reason of its precipitation by the alkaline 
juices there present. Many clinicians claim that remittent fever is 
chiefly benefited by quinine during the remission, and cinchonism 
during the pyrexial stage undoubtedly increases the discomfort of the 
patient. If pyrexia is excessive, relief must be sought in the cold 
pack or antipvrine. Cure is much facilitated by absolute rest in 
bed. 

The best treatment of the vomiting is the use of small doses of 
morphine, or 3- to 5-minim (0.15-0.3) doses of the spirit of chloro- 
form in from 30 drops to 1 drachm (2.0—4.0) of cherry-laurel water. 
Aconite may also be used if the patient is strong enough. (See 
Vomiting.) 

If the belly is tender, a turpentine stupe should be applied. (See 
Turpentine.) 

If intestinal hemorrhages occur, gallic and tannic acids or Mcn- 
sel's salt, in the dose of 3 grains (0.15) in hard pills, may be used, 
and cold cloths be placed over the belly. (See Hemorrhage.) 

If haematuria appears, quinine must be avoided unless the neces- 
sity for its employment is absolute because of the frequent recur- 
rence of paroxysms. Quinine in some cases increases the haema- 
turia. (See Collective Investigation by author in Therapeutic Gazette, 
July, 1892.) 

The treatment of convalescence consists in the use of tonics, such 
as quassia, calumba, gentian, Huxham's tincture, arsenic, and purga- 
tives when needed, with attention to the kidneys, the potassium salts 
being employed to keep these organs active. (See Intermittent Fever.) 

RETINITIS. 

Retinitis, or inflammation of the retina, often associated with cho- 
roiditis, is commonly the result of several constitutional diseases: 
Bright's disease, diabetes, syphilis, etc. In some cases no cause can 
be found. The general remedies must be directed according to the 



RHEUMATISM, ACUTE ARTICULAR. 733 

supposed cause, and the eyes must be protected from light and all 
close work avoided. Very distinct retinal irritation may be caused 
by eye-strain, which is to' be relieved by the prolonged use of atro- 
pine and dark glasses, and later suitable lenses for the correction of 
any existing error in refraction. 

RHEUMATISM (ACUTE ARTICULAR). 

No better example of the fact that therapeutics is in advance of 
pathology can be adduced than the disease known as rheumatism. 
The therapeutist cannot tell how he cures the condition designated 
by this name, simply because the pathologist cannot tell what the 
cause of the disease is, and when this information is forthcoming 
from the one side, an explanation will be immediately given by the 
other. This being the case, we must devote ourselves to the study 
of pure empiricism, and not to logical pharmacology. 

The treatment of acute articular rheumatism is divided into that 
portion devoted to the cure of the disease-process, and that directed 
to the relief of the pain and of the local manifestations of the dis- 
ease. 

When an acute attack of rheumatism comes on, it is nearly always 
accompanied by a high temperature, a bounding pulse, and all the evi- 
dences of the active systemic disturbance accompanying inflammatory 
outbreaks, which, in this particular instance, involve the joints. We 
may therefore use at such times the remedies which we have learned 
are best able to combat inflammation — namely, aconite and veratrum 
viride. So powerful are these drugs in the early stages of acute 
rheumatism that some persons have believed them to be possessed of 
a specific antirheumatic power. This is, however, highly unlikely, 
as they act no better here than in other inflammatory conditions else- 
where. 

The proper manner in which to use the tincture of aconite under 
these circumstances, in a strong, healthy individual, is to administer 
3 minims (0.15) at once in a little water, and follow it by a teaspoonful 
of a mixture containing 5 minims (0.3) of tincture of aconite and 2 
ounces (60.0) of water, every half-hour until perspiration on the skin 
betokens circulatory depression through the action of the drug. If 
this is not used, veratrum viride in the same proportions may be 
given. The advantages of this treatment are numerous; first, it allays 
the fever; second, it quiets nervous excitability; third, it tends to 
prevent permanent changes in the joints which are involved; and, 
last of all, it aids in the production of a sweat. Whenever these 
drugs are employed the patient must be strong and hearty, not debil- 
itated or weak, and it is to be noted that this treatment is not to be 
resorted to carelessly. Finally, care is to be taken that the symp- 
toms of depression from the drug and the disease combined do not 
become too severe. Where great exhaustion is primarily present or 
ensues upon the use of depressant drugs, alcoholic stimulants are 
particularly needed, and carbonate of ammonium and aromatic spirit 
of ammonia are valuable. 



734 DISEASES. 

Simultaneously with these internal measures a solution of bicar- 
bonate of sodium, 20 grains to the ounce (1.3 : 30.0), may be applied 
to the joints involved, by means of lint wet with this solution, with 
relief to the sense of heat or burning, or ice-cold compresses may be 
tried. In other cases relief may be obtained by applying hot cloths 
saturated with the so-called Fuller's lotion — namely, carbonate of 
sodium 6 drachms (24.0), laudanum 10 ounces (300.0), glycerin 2 
ounces (60.0), and water 9 ounces (270.0). Sometimes great relief is 
obtained by fixation of the joints by means of splints. 

A most valuable application to the inflamed joints of rheumatism, 
either during the acute stage or afterward when they remain swollen 
and enlarged, is : 

R.— Ichthyol ^iv vel ^j (16.0-30.0). 

Lanolini ^ij (64.0).— M. 

S. — Hub in well and apply about the inflamed part on lint. 

In other cases the acute stages of the inflammation may be com- 
bated with advantage, particularly where there is gastric disorder, by 
the local application of salicylic acid made into an ointment with an 
animal fat, not vaseline or glycerin, as it is not absorbed when so 
mixed. According to Bourget, this treatment is best suited to blondes 
and young persons, as absorption is more rapid in this class of 
patients. The following salve may be prescribed : 

R. — Acid, salicylic 3j (4.0). 

01. terebinthin TT\,xxx (2.0). 

Lanolin gj (32.0).— M. 

High fever is to be controlled by the same measures as the high fever 
of any other disease — by cold sponging, or sponging with tepid water, 
and sometimes by the use of antipyretic drugs, the use of which is 
more justifiable in this case than in ordinary fevers in that they tend 
to relieve the pain. 

Immediately after the system has been thoroughly impressed by 
cardiac sedatives — or at once and in their place if the case is not seen 
at first or is weak — the physician should resort to one of three reme- 
dies — namely, salicylic acid or its salts, acetanilid, or antipyrin. The 
general opinion of the profession seems to be that these three remedies 
stand in the order here placed in regard to their efficiency, but it is 
also true that one will often succeed when the other fails, and it is 
worthy of note that success or failure generally asserts itself rapidly ; 
that is, the drug used gives relief in from forty-eight to seventy-two 
1 1 ours or fails altogether. It is most important to remember that sali- 
cylic acid protects the cardiac valves and the entire endocardium from 
the ravages of the disease only by shortening the attack, and not by 
any direct influence, and in addition that this acid, by reason of the 
profuse sweats often produced by it and its tendency to cause cardiac 
depression, must be watched lest it act unfavorably on the general 
systemic state. 

Taking up salicylic acid first, we find that its proper use is often 
misunderstood, and that it fails sometimes because of this fact. When- 
ever acute articular rheumatism appears the salicylic acid should be 



RHEUMATISM, ACUTE ARTICULAR. 735 

pushed in the same way that we use quinine on the advent of a 
malarial paroxysm — namely, in full dose. 

It is useless to give salicylates in 5- or 10-grain (0.3-0.65) doses 
three times a day ; they must be given in 20-grain (1.3) doses, morn- 
ing, noon, and night, or oftener, or not at all. If the sweats are too 
severe or the stomach rebels, they may be stopped, but not decreased 
in amount unless for good reason. Further than this, if salicylic acid 
is used for two or three days in this way, and produces evidences of 
cinchonism, yet fails to alter materially the course or severity of the 
trouble, it should be withdrawn, as it will rarely if ever do any good 
after this time. (See article on Salicylic Acid.) 

In the author's experience the salicylate of strontium is a very 
useful substitute for the acid, as it is less apt to irritate the stomach. 

Clinical experience seems to show that if sodium bicarbonate is 
given in full doses with the salicylates, better results are obtained 
than if the sodium is not used. The dose of the bicarbonate of sodium 
should be about 20 or 30 grains three or four times a day. It is also 
thought that this mixture protects the heart, whereas the salicylate 
when given alone fails to do so. 

Another very efficient substitute for salicylic acid is the oil of 
gaultheria (wintergreen), which contains over 90 per cent, of salicylate 
of methyl. The dose should be 10 to 20 minims (0.65-1.3) on a tea- 
spoonful of sugar or in capsule or emulsion three times a day, after 
meals. (See article on Graultheria.) 

Antipyrin and acetanilid may both be considered together, since 
their action is identical in rheumatism. The author believes that 
antipyrin, while often relieving the pain more than the acetanilid, 
nevertheless does not act so favorably in decreasing the duration of 
the disease. The dose of the first should be 5 to 10 grains (0.3-0.65) 
three times a day; of the second, 4 to 8 grains (0.2-0.6) at the same 
intervals. 

The studies of Guttmann with acetanilid in a very large number 
of cases of rheumatism, embracing all its forms, both chronic and 
acute, have given most encouraging results, and the author has seen 
the drug act most happily in cases which had refused to yield to 
the iodides and salicylates, although all of these cases were of the 
severe acute form, suffering intense pain from the articular inflamma- 
tion, but devoid of any cardiac complications. It at once becomes 
evident that a drug such as antipyrin or acetanilid may do good in 
a case of rheumatism in three entirely separate and distinct ways, any 
one of which may be active at once or all active together, hand in 
hand, in the improvement of the patient's state. Any substance pos- 
sessing strong antipyretic power must be of value under such circum- 
stances, because of the lowering of the fever which follows its admin- 
istration, with the resulting quieting of an excited system, and in 
putting aside the delirium associated with a condition of hyperpy- 
rexia. Not only does such a drug act favorably in this manner, but 
the analgesic effects of such a substance must exert a powerful influ- 
ence for good. By benumbing the sensibility of the patient to the 
excruciating pain consequent upon movement, and so putting aside 



736 DISEASES. 

the nervous wear and tear of sleeplessness and suffering, the patient's 
state must be improved, or at least not grow worse from the exhaus- 
tion of the long hours of agony. Further than this, it would seem 
probable that acetanilid possesses a direct antirheumatic influence, 
allaying the disease-processes even in those forms in which, pain not 
being present in a severe form, the improvement must be real and 
not fictitious. 

The intention of the author is not to extol the value of acetanilid 
and antipyrin in rheumatism to the exclusion of other means of re- 
lief, nor to recommend their use before the more thoroughly tried sali- 
cylates and iodides, but to draw to their standard a certain number of 
cases which persistently resist treatment of the ordinary stamp, and 
which put the physician to his wit's end for a change of treatment at 
least promising some chance of relief. Many of the readers of this 
book have doubtless seen such cases, and many of them must have 
learned by sad experience that acute articular rheumatism is in many 
cases bound to run a course of so many weeks or days, do what we 
will. Under these circumstances nothing acts further than a pal- 
liative, and the patient and his friends become impatient for a change. 
The author has found that acetanilid in such cases will often relieve 
the pain, and so permit a refreshing sleep, in doses of from 4 to 8 
grains (0.2-0.6) three times a day, and that these amounts do not 
cause the excessive sweating which the necessarily large doses of 
salicylate are sure to produce — sweats which leave the patient often- 
times almost dyspnoeic from very weakness. Whether this temporary 
relief produces such changes in the system as to permit of a better 
battle against the disease, or whether it actually counteracts the rheu- 
matic poison, we know not; but we do know that after the use of ace- 
tanilid the relief is not only temporary, but often permanent, and 
that a very distinct step in advance is made toward the close of the 
attack if any influence at all is felt. 

The following prescription, which is of additional value because 
the caffeine supports the heart and increases urinary secretion, is 
recommended : 

R.— Acetanilid gr. xl (2.6). 

Caffein gr. xx (1.3). 

Camphor, monobromat gr. xx (1.3). — M. 

Ft. in capsul. vel pil. No. xx. 
S. — One every three hours or three times a day. 

Phenacetin is often very useful when used in rheumatism for the 
relief of pain, particularly if combined with salol. 

Passing from what may be appropriately called the coal-tar treat- 
ment of rheumatism, because all the drugs so far named for internal 
use have such a source, we come to a list of remedies heretofore 
largely used in rheumatism in place of the newer compounds, but 
which are not so commonly employed to-day. 

These remedies act, as a rule, in the subacute forms of rheumatism 
or in the cases where the first group fail because the disease is obsti- 
nate. Of these the chief is the iodide of potassium, followed by the 






RHEUMATISM, ACUTE ARTICULAR. 737 

acetate, bicarbonate, and citrate of potassium. If the iodide is used, 
the following prescription is of service : 



, 



R. — Potassii iodidi ^j (32.0). 

Syr. sarsaparillse comp f^vj (180.0).— M. 

S.— Dessertspoonful (8.0) three times a day, after meals. 



In other cases it is best, because of the disagreeable taste of the 
odide, to give it in sugar-coated pill or in tablet form, but care should 
be taken that milk or water is taken at the same time to prevent 
gastric irritation. 

Or, if preferred, 20 to 30 grains (1.3-2.0) of the bicarbonate of 
potassium may be taken every four or five hours in water flavored with 
cinnamon for the sake of the taste, or the citrate of potassium, which 
is more agreeable, may be taken in equal amount. Sometimes a little 
colchicum added to the prescription given above may be useful if the 
case is very obstinate, as follows : 

R .—Potassii iodidi gj vel ^ij (32.0-64.0). 

Vini colchici radicis fgij vel f t |ss (8.0-16.0). 

Syr. sarsaparillse comp. . . q. s. ad f^vj vel f Jxij (186.0-370.0). — M. 
S. — Dessertspoonful (8.0) three times a day, after meals. 

Haig claims that in rheumatism there is retention of uric acid, and 
that the use of alkalies and the salicylates at once causes this substance 
to be changed into a soluble form ready for elimination. 

The other drugs used in acute rheumatism are numerous, but only 
a few of them deserve attention here. There is abundant evidence 
on record that full doses (10 to 30 minims [0.65-2.0]) of the fluid 
extract of cimicifuga if given every five hours will decrease the red- 
ness and pain of the joints and shorten the attack in some cases. 
Again, certain species of rhus, as rhus toxicodendron, are said to be 
useful if fresh preparations are at hand. The dose of rhus toxico- 
dendron is y 1 ^- to 1 minim (0.006-0.05) of a tincture made by adding 
1 part of the fresh leaves of poison-ivy to 2 parts of alcohol, this dose 
being taken three times a day. Where the pain seems particularly 
severe at night this drug is very valuable, according to many active 
students of therapeutics, but the writer has had no experience with it. 

Nearly every case of acute rheumatism will do better if a strong 
mixture of lemon- or lime-juice and water be taken daily in large 
quantities. 

The local remedies in the later stages of acute rheumatism are 
chiefly counter-irritants and sedatives. Thus, small or large blisters 
applied around an inflamed joint after the general systemic excite- 
ment has passed may be of great value in restoring the suppleness of 
the joint and in aiding in the absorption of the effusion. The remain- 
ing local treatment consists in thoroughly painting the inflamed parts 
with tincture of iodine if blisters are not used, or in the application 
of veratrine ointment or iodine ointment around the joint. (See 
Veratrina.) Sometimes the application of ichthyol and lanolin in 
equal parts, also rubbing this ointment into the tissues thoroughly, 
will aid in the absorption of inflammatory exudations. 

In this connection we must not forget the very great value of mor- 

47 



738 DISEASES. 

phine in endocarditis, myocarditis, and pericarditis ; for not only does 
this drug give relief from the pain, but it diminishes the patient's 
anxiet}^, quiets his restlessness, and slows the pulse by this means and 
by direct action upon the circulatory system. This question of slow- 
ing the heart does not receive sufficient attention. When we consider 
that a difference of ten beats a minute amounts up to 600 beats per 
hour, and to nearly 15,000 beats a day, we can see how comparatively 
slight variations in pulse rate may mean very great variations in the 
amount of work done by the heart in twenty-four hours. For the pre- 
vention or relief of endocarditis the application of a number of small 
blisters over the prgecordium seems to be a very valuable measure ; 
or, in their place, 8 to 12 leeches may be placed over the heart and 
followed by the application of an ice-bag. (See article on Pericarditis.) 
No drugs can serve to protect the heart so well as complete physi- 
cal rest. Not only is this necessary during the attack, but for several 
weeks afterward; and if the patient gets up too soon, a hidden, unsus- 
pected valvulitis may gradually develop into a fatal lesion. The 
lame valve must be given time to recover before it is given more work 
to do. This is perhaps the most important therapeutic fact in regard 
to the therapy of this disease. 



RHEUMATISM (CHRONIC). 

Chronic rheumatism is one of the most difficult and obstinate dis- 
eases with which we have to deal. In some cases the acute form just 
considered merges slowly into the chronic form, or, in other instances, 
the disease gradually comes on, increasing, it may be, by exacerba- 
tions or by gradual progression. The treatment of chronic rheuma- 
tism is somewhat different from that of the more acute forms, and 
approaches that of gout in some of its therapeutical indications. In 
other words, the salicylates are not so useful in these cases as are the 
iodides and colchicum, so that in the majority of instances the pre- 
scription of iodide, sarsaparilla, and colchicum given in the article on 
Acute Rheumatism is indicated. When anaemia or weakness is pres- 
ent, cod-liver oil is often of great service, and it is worthy of note that 
this useful nutritive remedy was first brought into therapeutics by 
the fishwives of Holland, who found it useful in the attacks of rheu- 
matism to which their husbands were subjected through exposure. 

When the oil is thoroughly rubbed into chronically-inflamed joints 
it is almost as useful as when taken internally. 

The same forms of severe counter-irritation are not so useful in- 
chronic rheumatism as in acute rheumatism, but a very valuable 
therapeutic measure in these cases is the use of the Russian or Turk- 
ish bath or an improvised sweat by means of a lamp and a blanket. 
(See Heat, and Cold.) Liniments are always called for, for two 
reasons : First, they relieve pain and do good to the parts, if not 
from their medicinal properties at least by the rubbing which accom- 
panies their application: second, because they give the patient some- 
thing to do or to have done, and therefore impress him with the 






RHEUMATISM, CHRONIC. 739 

object-lesson that his attendants are attentive and alive to his suffering 
and need of sympathy and care. 

Among the lower classes the belief in liniments is very widespread, 
and their use will often instil into the minds of the friends a far 
greater confidence than the most rational of treatments with the lini- 
ment left out of the list of remedial measures. 

The following liniments will be found very useful under these 
circumstances : 

R.— Tr. aconiti f^ij (8.0). 

Tr. opii . . . f gj (30.0). 

Olei terebinthinae f |j vel f^ij (30.0-60.0). 

Linimenti saponis q. s. ad f|viij (240.0).— M. 

S. — Poison. Use as a liniment three times a day. 

Or, 

R. — Aquae ammonias fortior f.^iv (16.0). 

Olei cajuputi fgj (4.0). 

Tr. belladonnas f Jj vel fgij (30.0-60.0). 

Linimenti carnphoras . . . . q. s. ad fjfviij (240.0).— M. 
S. — Poison. Use as a liniment. 



Or, 

J 



R .— Tr. opii 

Tr. aconit. \ aa f^iv (16.0). 

Aquas ammon. fort. 

Linimenti chloroformi f^vj (180.0). — M. 

S. — Poison. Use as a liniment to chronically-inflamed muscles or joints. 



In other instances the greatest relief is obtained by employing 
the following ointment of veratrine : 

R. — Veratrinas gr. xxx (1.6). 

Hydrargyri iodidi flav gj (4.0). 

Petrolati gij (60.0).— M. 

S. — Use as an ointment over the joints. 

This ointment ought not to be widely distributed, and the pulse ancl 
respiration should be watched, as the veratrine may be absorbed and 
depression of a severe character set in. 

For the reduction of enlargements of the joints due to the dis- 
ease, and accompanied in some cases by pain, the following ointment 
is serviceable : 

R.— Unguent, iodi Jj (30.0). 

Adipis 3iv vel ^j (16.0-32.0).— M. 

S. — Apply locally. 

Or, still better, 

R.— Ichthyol ziv to gj (16.0-32.0). 

Adipis m |j (30.0).— M. 

S. — Kub into the joints thoroughly. 

Ichthyol is certainly the most efficient remedy that we have for 
the enlarged and painful joints. 

The employment of red flannel over inflamed joints is no better 
than the use of white flannel, and it is never beneficially "medi- 
cated," as claimed in the stores. The only advantage of red flannel 



740 DISEASES. 

is that, as it is dyed, the wool is often better for not being thoroughly 
bleached, and is in larger amount. The disadvantages of red flannel 
are that if the patient sweats it stains the clothes, and the possibility 
of its producing irritation of the skin or even systemic effects of 
an evil character. 



RICKETS. 

Rickets may be defined as a state of the body of an infant or child 
in which there is a deficiency of the normal salts of the bones and 
tissues, with corresponding enlargement of the organic portion of the 
bone, or. in other words, the cartilaginous parts. Generally the term 
is applied solely to designate bony troubles, but every practising 
physician sees cases where the manifestations of rickets are empha- 
sized in gastro-intestinal disorders rather than in bony deformities. 
The chief cause of rickets in children, aside from the presence of any 
disease, such as scrofulosis, is inanition ; that is, non-nutrition of a 
specialized form, or, in other words, bone-salts starvation. This may 
occur after or before birth, and it is quite common to see children, 
born of mothers ill-fed or whose assimilation of salts is defective, with 
soft bones or a distinct tendency to rickety development. 

The treatment of rickets is therefore largely dietetic and devoted 
to the improvement of the food and digestion, for the condition is 
typically one of failure of assimilation more than of starvation of bone 
salts. No part of the body fails in force more than the digestive 
apparatus in the presence of this disease, probably because the alka- 
linity of the blood is altered, and partly because the stomach cannot 
secrete properly -formed juices from imperfectly-nourished glands. 

The medicines to be used in rickets are general tonics, digestives, 
and stimulants, and bone tonics, such as salts of lime and phosphorus. 
The general tonics are quinine, and cod-liver oil, nux vomica, and 
iron, while the digestive tonics are the simple bitters, physostigma, and 
mineral acids. 

Tonic treatment is best carried out in young children by the admin- 
istration of quinine in the form of quinine chocolates or by the use 
of strychnine in the dose of -^to to y^- of a grain (0.0003-0.0006) 
in sugar-coated pink granules. Arsenite of copper in the dose of 
jl tT of a grain (0.0006) in tablet triturate three times a day is also 
useful. 

A very useful preparation is the following : 

B.— Olei raorrhuse f^vj (24.0). 

Svr. calcis lactophosphat. \ aa f^iij (90.0).-M. 

Liquor calcifl I a j \ / 

S. — \ to 1 teaspoonful (2.0—1.0) two or three times a day. Shake thoroughly. 

Nux vomica is so bitter as to be difficult of administration to young 
children, and when given only \ to \ of a minim (0.008-0.010) of the 
tincture should be used, three times a day. 

Where a distinct scrofulous tendency exists and anaemia is present 
small doses of the syrup of the iodide of iron are of service, and T ^ 



SCARLET FEVER. 741 

to 1 minim (0.006-0.05) may be given three or four times a day to a 
child of six months or a year, thus : 

R. — Syrupi ferri iodidi gtt. iij vel xxiv (0.15-1.5). 

Aqua? dest q. s. ad fgiij (90.0).— M. 

S. — Teaspoonful (4.0) every four or five hours during the day. 

Or, 

R. — Syrupi ferri iodidi gtt. v vel xx (0.3-1.3). 

Syrupi q. s. ad f§iij (90.0).— M. 

S. — Teaspoonful (4.0) three times a day, after meals. 

Here, again, arsenite of copper is a particularly valuable remedy. 

The salts of lime and sodium are of direct benefit to the bones, 
forming by their presence in health a large proportion of the osseous 
system, and therefore they may be considered as foods rather than 
drugs. Very often their administration to nursing mothers or preg- 
nant women saves the maternal teeth from caries and preserves the 
general health of the mother and child. The following prescription 
may be used : 

R. — Syrupi calcis lactophosphatis ffiv (120.0). 

S. — J to 1 teaspoonful (2.0-4.0) three times a day, after meals. 

The reasons for the use of phosphorus are clear, from what has 
been said of that drug when speaking of it elsewhere in this book, as 
it acts as a direct and powerful stimulant of bone-growth. 

Phosphorus is best given to children in the form of very small 
sugar-coated pills (yj-g- gr. [0.0003]), such as are put up in the form 
known as "pink granules " by manufacturing chemists. 

The ventilation of the rooms where a child prone to rickets is kept 
should be excellent, not too hot or cold and free from draughts. A 
cool sponge-bath is useful at night if the patient is strong enough, or 
a good rubbing with salt and whiskey, 1 drachm (4.0) of salt to a pint 
(500 cc.) of whiskey, is of still greater service. 

Special attention should be paid to the development of the muscles 
by massage and passive movements, as these parts are always weak. 
Walking must not be allowed too early, as it may cause bony 
deformities. 



SCARLET FEVER. 

This disease, the most fatal of all the exanthematous diseases of 
childhood, requires the greatest care in its treatment. Complica- 
tions constantly arise requiring skill on the part of the attendant, 
and it is upon his success in treating these outbreaks, as well as 
in the general direction of the case, that the life of the patient 
chiefly depends. It has been claimed by certain practitioners that 
one or two remedies, which they have used, act as abortifacients of 
the attack, decreasing its severity, its duration, and the probability of 
complications. Thus, one European physician has used salicylates 
with wonderful results, if his claims are true, for he found them to 
prevent all complications and even to remove them when present. 



742 DISEASES. 

He gives, throughout the entire attack and for some days after defer- 
vescence has ensued, the following : 

R — Sodii salicvlat gr. xlviij (3.0). 

Aquae destillat f^ij (8.0). 

Syr. aurantii q. s. ad f ^iij (90.0). — M. 

S. — Teaspoonful (4.0) every hour during the day and every two or three hours 
at night, in a little water. 

In this country some practitioners have employed chloral through- 
out the entire attack, with asserted good results, but in the opinion 
of the author this method is not the best for most cases, unless the 
nervous manifestations are very marked, when the chloral treatment 
is of great value. 

As a rule, the drug is easy of administration and well borne by the 
stomach. Its acrid after-taste is best masked by its administration in 
Aubergier's syrup of lactucarium, thus : 

R.— Chloralis _ gr. xxx (2.0). 

Svrup. lactucarii (Aubergier) ") -- ev. i «■ /ic n on n\ at 
Aqu^dest. } ■ aa fgss vel fgj (16.0-30.0).~M. 

S. — A teaspoonful (4.0) in iced water every two, three, or four hours, if possible 
after food. 

The convulsions which sometimes usher in an attack are to be 
treated by 5-grain (0.3) doses of chloral and 10 to 20 grains (0.65- 
1.3) of bromide of sodium for a child of five to eight years. The con- 
vulsions of the advanced stages are often unemic, and must be treated 
accordingly. (See Uraemia.) 

From the very beginning of an attack to its end the child should 
be supplied with plenty of pure water, and, if possible, this water 
should be obtained from a spring containing a low percentage of solids, 
as Poland water, which is widely sold throughout this country. If this 
is impossible, then Celistin's Vichy water may be employed, or an effect 
produced by obtaining the granulated Vichy salts sold by most large 
drug firms, and adding this in small amounts to pure filtered or dis- 
tilled water. This makes an effervescing draught which may be taken 
while bubbling or not, as the child desires. The object of this treat- 
ment is to flush out the kidneys, and to so dilute the effete matters 
generated in the body by the fever and the germs of the disease that 
they lose, to a great extent at least, their poisonous and irritating 
powers. 

In other cases a prescription containing sweet spirit of nitre and 
citrate of potassium proves useful, as follows: 

R.— Spt. aether, nitros f&j (30.0). 

Potassii citratis ^ij (8.0). 

Aquae desk . . ... . q. 8. ad f 5vj (180.0).— M. 

S. — Teaspoonful (4.0) every two hours i f the urine is high-colored. 

The further treatment of tlio disease rests upon the symptoms alone. 
We cannol cure the patient by the use of remedies, but we can do 
much toward making the pathway to health smooth and free from pit- 
falls and obstructions. 



SCARLET FEVER. 743 

Probably the most common complications calling for treatment, 
when the kidneys have been treated in the way just spoken of, are 
high temperature or fever, and sore throat or angina. The fever is to 
be controlled in these cases in precisely the same way that it is in all 
other conditions in which it is present. It is best to attempt to keep 
it down below 101°, or at least below 102° F., by tepid sponging, 
which also allays the itching of the skin, or, if the fever still rises, by 
the use of colder water. Generally the popular fear that the application 
of cold to the surface will drive the eruption " inward " is so strong as to 
make the cold sponging objectionable in the eyes of the friends; but if 
the temperature reaches 105° F., the physician must assert the fallacy 
of this belief and insist on its use. (See Cold, Part III.) When the 
patient is overcome by toxaemia, the skin marbled and mottled, and 
the brain stuporous, he should be placed in a bath at 100° F., and 
cold water at 60° or 70° F. poured on his head and shoulders with 
some force. The results are most beneficial. If suppression of 
the rash occurs, we must use the wet pack. (See Heat, Part III.) 
Antipyrin and acetanilid, to be sure, may both be used, but it is 
worthy of note that each of these may produce collapse or other com- 
plication if large doses are necessitated by an obstinately high tempera- 
ture. If these complications ensue, alcohol will be indicated. Quinine 
has been highly recommended as an antipyretic in scarlet fever; but it 
is of little value in the majority of cases, simply disordering the stomach 
and irritating the kidneys if used in doses large enough to be effective. 
Where the head seems to be particularly hot and the fever is high an 
ice-bag or a head-coil of rubber tubing is to be employed, and through 
the latter water may be circulated at whatever temperature is thought 
best. (See Cold, Part III.) 

The treatment of the sore throat of scarlet fever is an important 
part of the care of the child in many cases. Small pellets of ice 
may be held in the mouth and an ice-bag applied to the outside of 
the throat. This is done by finely breaking up some ice and placing 
it in a thin india-rubber bag about the neck, the surface of the bag 
being covered by a cloth to prevent too rapid melting of the ice and 
the wetting of the clothes by the condensation of moisture on the 
surface of the bag. This treatment should be used during the entire 
attack if needed, and the contents of the bag renewed as often as 
the water becomes at all warm from the heat of the body. By this 
means the redness of the fauces and the swelling of the glands of 
the neck is relieved. Chlorate of potassium may be used in a spray 
or on a swab, but never internally, owing to its irritant effects upon 
the kidneys and stomach and its general influence on the blood. 
When a false membrane forms, antidiphtheritic serum is to be given 
until a bacteriological examination shows that it is not due to the 
Klebs-Loeffler bacillus. 

In cases where the eruption fades or is never very prominent it 
is of the greatest importance that it be made active. Under these 
circumstances the child may be placed in the warm wet pack, and, if 
the head is very hot, cold applied to the vertex and throat while the 
body is enveloped in the blanket. (See Heat.) This often brings out 



744 DISEASES. 

in an hour or two a bright scarlet rash, and the child falls asleep and 
wakes up free from delirium and high fever. 

The itching and burning of the skin in many cases of scarlet fever 
are annoying symptoms, and they may become really dangerous. The 
author has recently carried out a series of experiments showing that 
fever of high degree can be brought on solely through nervous irri- 
tation, thus explaining a fact long well known to clinicians — namely, 
that the relief of this dermal irritation in scarlet fever may be fol- 
lowed by a fall of temperature. To relieve this symptom it will often 
be found advisable to cover the entire skin with a thin layer of vase- 
line or cosmoline or benzoated lard, or, in other cases, as an antiseptic 
and local anaesthetic, carbolized oil may be applied (2 minims of car- 
bolic acid to each 2 ounces [0.1 : 60.0] of olive oil). In other cases 
almond oil should be used. 

If nephritis comes on and in a severe form, the greatest Care 
is necessary, and the object of the physician must be to make the skin, 
disabled as it is, carry out a sufficiently active eliminative function to 
relieve the kidneys of any strain, to remove dropsy, and to aid in the 
removal of effete matter by producing catharsis. Sweating may also 
be produced by the employment of heat obtained by the use of bottles 
of hot water or hot bricks placed about the patient, who is first 
wrapped in blankets, so arranged that sweating will come on, and 
so that the bottles cannot burn the skin. The thermometer must be 
placed in the mouth to foretell any danger from heat-stroke if the 
sweat should fail to appear. In such cases the hot pack is of great 
value. (See Heat.) 

The after-treatment of scarlet fever during convalescence consists 
in the use of Basham's mixture or the tincture of the chloride of iron, 
and in the employment of simple bitters, strychnine, or quinine. 
Fresh air, sea-air or mountain-air is useful, while cold or exposure 
to cold air or draughts is to be carefully guarded against. 



SCIATICA. 

Sciatica is an exceedingly obstinate affection, in the majority of 
cases resisting the best treatment for weeks. It seems to be due to 
rheumatic taint in the majority of instances, and may sometimes be 
cured by the remedies used and described under the heading of Acute 
or Chronic Rheumatism. In other instances it is due to injury or 
jarring of the nerve, as by heavy persons stepping off from a high 
step to the hard ground. Thus the most obstinate case ever seen by 
the writer was one in which a stout man weighing about two hundred 
and fifty pounds acted as "coupler" on a switching engine, and, 
though wonderfully agile for his weight, provoked the disease in the 
leg on which he always first struck the ground when jumping from 
the platform of the moving locomotive. 

The treatment for all cases is both internal and external. The 
internal treatment may be the same as that already described under 
Acute or Chronic Rheumatism, or in other instances consists in the 



SCLEBITIS. 745 

use of large doses of bitartrate or citrate of potassium, 40 grains 
(3.0) three times a day, in plenty of water to aid in the maintenance 
of free kidney action. At the same time the amount of coffee and 
tea should be cut down as much as possible, and lemonade, strongly 
acid, be taken freely during the day. If the pain is very excessive, 
morphine should be given, or antipyrin, citrophen, or acetanilid may 
be used. In some instances methylene blue in 5-gr. (0.3) doses twice 
or thrice a day have seemed to relieve pain. 

The local treatment of sciatica is quite various. One of the 
favorite methods is to inject deeply into the flesh, just over or about 
the exit of the nerve from the pelvis, 10 to 20 minims (0.65-1.3) 
of chloroform, or instead of the chloroform -J-' to J grain (0.01-0.016) 
of morphine, in 30 minims (2.0) of w r ater w T hich has first been dis- 
tilled and sterilized, may be used with equally good results and less 
danger of sloughing. The pure chloroform is apt to cause an 
abscess. Other physicians prefer acupuncture, the needle being 
driven down until the sheath of the nerve is punctured. Still another 
useful method is to take a strong glass rod with a round, smooth end, 
and, after anointing the skin over the course of the nerve with a little 
ichthyol ointment or lard, to pass the end of the rod back and forth 
over the tender area, using as much pressure as can be borne. By 
this means massage or pressure on the nerve is accomplished. In 
other cases the daily use of an ether or rhigolene spray over the part 
is effective, or kataphoresis may be resorted to. In still others, from 
three to five large wet or dry cups, preferably the wet, may be placed 
along the course of the sciatic nerve with great advantage. In many 
cases absolute rest of the limb, obtained by placing it in splints, has to 
be adhered to before cure can be possible. Hot-w r ater bags should be 
placed continually about the exit of the sciatic nerve from the pelvis. 

The liniments recommended in chronic rheumatism may be tried, 
and cod-liver oil is of service in obstinate cases. Sometimes nerve- 
stretching must be performed before a cure is effected. 



SOLERITIS. 

Scleritis, or inflammation of the sclera, consists in a bluish-red, 
somewhat elevated patch, with implication of the overlying episcleral 
tissue (episcleritis). In the earlier stages pain and photophobia, if 
present, require atropine and boric acid and compresses of hot water ; 
later, the infiltration may be subdued with yellow-oxide-of-mercury 
ointment, associated with massage. If the disease spread and impli- 
cate the cornea and iris, the treatment useful in ordinary iritis is in- 
dicated. In stubborn episcleritis, without iritis, which does not yield 
to these measures, eserine, usually accompanied by pilocarpine sweats, 
should be tried, and even the actual cautery has been recommended. 
The disease in many instances is associated with rheumatism, syphilis, 
scrofula, anaemia, and menstrual disorders : these must always receive 
the needed constitutional treatment, especially if iritis or keratitis 
ensue. Scleritis is a disease hard to eradicate and subject to frequent 
relapses. 



746 DISEASES. 

SCROFULOSIS. 

Scrofulosis is to be treated by hygienic measures rather than 
drugs — fresh air, residence by the seaside, proper out-door exercise, 
massage, and dietetics, all of which take precedence of medicines. 

If these necessary adjuncts to a cure are obtainable, the prognosis 
is fair, to say the least, and the following drugs may be used, all of 
them being devoted to the improvement of the general health, and 
not to any direct influence over the scrofulous tendency in itself. It 
is hardly necessary to state that cod-liver oil (or its supposed active 
principles combined under the name of morrhuol) is perhaps the best 
remedy of all. The oil should be given in emulsion, being first pan- 
creatized and so prepared as to be somewhat palatable by the addition 
of flavoring substances if the child is old enough to appreciate such 
flavors. In young children, while distaste of the oil is often shown at 
first, a liking for it rapidly develops, so that the writer has seen chil- 
dren cry for it when the oil was discontinued. It is nearly always 
best to combine the lactophosphates or the hypophosphites with the 
oil when it is given in these cases. Whenever anaemia is present, 
syrup of the iodide of iron is useful in from 1- to 10-minim (0.05-0.65) 
doses, according to the age of the child, as follows : 

R.— Syrupi ferri iodidi f.^ss vel f^ij (2.0-8.0). 

Aqwedest . . q. s. ad f jiij (90.0.)— M. 

S. — Teaspoonful (4.0) in water three times a day, after meals, to a child of one year. 

In these same cases jfa grain (0.0006) of arsenous acid or T -J-g- 
grain (0.0006) of corrosive sublimate may be given to a child of three 
or four years, in the form of tablet triturates, or the following pre- 
scriptions may be used : 

R. — Liquor potassii arsenitis ^xvj (1.0). 

Aquse destillat f^ij (64.0).— M. 

S. — Teaspoonful (4.0) three times a day, after food. 

Or, 

R . — Hydrarg. chlor. corros. . . gr. T \ vel gr. | (0.006-0.012). 

Aqua? destillat fgij (64.0).— M. 

S. — Teaspoonful (4.0) every five hours, after food. 

The use of the iodides is generally contraindicated in those cases 
where softening and breaking down of the glands are going on rap- 
idly. In their place we may employ the calx sulphurata, given by 
placing 1 grain (0.05) of it in half a tumblerful of water and giving a 
teaspoonful hourly. The mixture should be freshly made every day, 
to prevent its becoming oxidized. 

Where enlargement of the cervical glands takes place, iodine 
ointment, diluted, one-half of lard, should be well rubbed into the 
part twice daily, but it should be stopped at once if any signs of 
softening or fluctuation appear or if the skin becomes reddened. In 
cases in which these enlargements are persistent, ichthyol ointment is 
to be rubbed in, using the following formula : 

R.— Ichthyol zij vel iij (8.0-12.0). 

A.lipis 5j (30.0).— M. 

S. — Apply locally. 



SCURVY— SHOCK. 747 

If this is not followed by a cure, the glands should be excised or 
scraped and the cavity packed with iodoform, as in the majority of 
cases these enlargements will be found to be distinctly tuberculous. 
(See Adenitis.) 

SCURVY. 

Scorbutus is caused so frequently by dietetic lawlessness, and its 
cure is so completely dependent upon the use of proper foods, that 
almdst no drugs are to be employed in its treatment. The avoidance 
of all salted meats, or, more important still, the avoidance of those foods, 
be they what they may, which have caused the disease in a given case, 
is to be practised. 

The only remedies particularly indicated are lemon-juice or lime- 
juice or citric acid, the latter being far less valuable in all cases than 
the juice of the fresh fruit. Where lemonade causes indigestion this 
effect may be avoided by boiling it and allowing it to cool. The boil- 
ing precipitates certain poisonous and irritating albuminoids, and the 
supernatant liquid when taken away is devoid of any evil influence, 
and may be cooled and sweetened to suit the taste of the individual 
concerned. Arsenic and iron are of service in most cases, and rest 
and quiet are to be insisted upon. 

By far the more common form of scurvy is seen in bottle-fed babies. 
The child may or may not have rachitic manifestations. Generally it 
loses animation, becomes listless and peevish, evidently suffers pain in 
its body and limbs when it is lifted from the bed, and looks feeble and 
wan. The gums become spongy and swollen, and have an ecchymotic 
appearance, and light blows produce bruises out of proportion to the 
severity of the injury. The treatment of infantile scurvy is a com- 
plete rearrangement of the child's diet-list, and varying its food. No 
one baby food should be used to the exclusion of another, and sterilized 
milk is to be supplanted, if possible, by fresh new milk. It is impor- 
tant to remember that a large proportion of these cases occur in the 
children of the rich, who have subsisted largely on prepared "Infant 
Foods." 

SHOCK. 

The medical treatment of shock is very important, and the life of 
the patient depends upon the care exercised by the attendant ; but before 
describing the treatment it is in place to consider the causes of the con- 
dition and the state of the injured person, so that we may understand 
the methods indicated. Every physiologist recognizes the fact that 
the body, particularly in its most vital parts, is controlled by inhibi- 
tory and accelerator nerves or nerve-cells, which govern the functions 
of all organs. Normally these two forces of inhibition and acceleration 
act in such a way as to be perfectly balanced, but abnormally they may 
either of them become excessive and overcome the other. Further 
than this, Ave must remember that all conditions of great functional 
activity are ultimately followed by a reaction which amounts to 
depression or exhaustion. 



748 DISEASES. 

Shock consists in an over-stimulation of the inhibitory apparatus 
which governs the heart and respiration, ultimately followed by ex- 
haustion of inhibition, so that the pulse and breathing become rapid 
and shallow instead of slow. Various degrees of shock can be readily 
recognized, and the severity of the condition always depends upon 
the constitution of the individual. Every one has heard a nervous 
woman say, "You frightened me so that my heart stood still," and 
again, a moment later, " Just feel how fast my heart is beating;" and 
we all of us know how any severe and sudden shock causes these 
changes to appear in the pulse to some degree. The same mechanism 
is the cause of great shock in railway or other injuries, only it is much 
more severe, owing to the actual injury received and its accompanying 
terrors. Many of the readers of this book probably know that a 
violent blow upon the belly-wall just over the solar plexus will cause 
death even in so large an animal as the ox, and every boy has had the 
" breath knocked out of him '' by a blow in this region. 

This period of inhibitory excitement speedily gives place to inhib- 
itory exhaustion, and we have a rapid pulse from inhibitory palsy, 
while through the palsy of the vasomotor system the blood-vessels are 
relaxed and the normal resistance to the heart is taken away. This 
vasomotor paralysis is the most important factor in the case. The 
heart beats wildly and fast for the same reason that a locomotive's 
Avheels fly round when the track is slippery — or, in other words, nor- 
mal resistance is lost. 

The capillaries in this second stage of shock are dilated, and the 
skin is relaxed, moist, and cold from excessive dissipation of heat. 
This is the more prolonged stage of the two, but they both need 
active treatment. 

The patient will rarely be seen in the first stage of shock, simply 
because by the time the physician reaches him the second stage will 
have come on. In either event the principal things to be done are 
the administration of ^ to ^ grain (0.001-0.0012) of sulphate of 
atropine hypodermically, and the application of external heat to main- 
tain the bodily temperature, the fall of which is a factor of great 
importance, but generally overlooked in attending to an operation or 
other measures of relief. The use of atropine is peculiarly a triumph 
of experimental therapeutics and rests upon logical deduction. It 
will be remembered that atropine in full dose acts as a depressant to 
the vagus nerve, and, as this nerve is over-active in the first stage, the 
drug acts as a sedative to it. This is, however, a comparatively un- 
important fact, for it is another action of atropine which makes it 
valuable. If the vagus be very much stimulated, a safe dose of atro- 
pine cannot quiet it, but in the second stage, which we most com- 
monly have to treat, a safe dose does not act so much upon the vagus 
as upon the vasomotor system, and by preventing the dilatation of the 
blood-vessels of the body thereby provides blood-paths of normal tone 
and tenseness, which do not holdall the blood in stagnant pools where 
it is not needed, but carry it to the brain and vital parts. Digitalis is 
a useful adjuvant to atropine in the second stage of shock because of 
its powerful vasomotor and cardiac influence. 20 drops (1-3) of the 



SMALLPOX. 749 

tincture of digitalis should be given hypoderniically, and repeated in 
an hour if the pulse does not show the influence of the drug at the 
end of that time. 

The application of heat in the form of hot-water cans, hot bricks 
or bottles, must not be forgotten, care being taken that the patient is 
not burned. (See article on Heat, Part III.) 

In many cases of surgical shock hypodermoclysis of hot saline 
solutions is of the greatest value, particularly if much blood has been 
lost. (See Hypodermoclysis, Part III.) 

SMALLPOX. 

The treatment of smallpox is not specific, simply because it is one 
of those diseases which run a given course and which we cannot 
abort. We can only treat the various symptoms which present them- 
selves, and by the modification of these manifestations prevent com- 
plications and sequelae to some extent. The fever is to be treated as 
is any fever of this class. Often it can be allayed by a mixture con- 
taining tincture of aconite, spirit of nitre, and spirit of Mindererus 
(liquor ammonii acetatis), while the headache or backache may be con- 
trolled by small doses of antipyrin or acetanilid. Mustard plasters are 
not to be used for the backache, as the dermal irritation will increase 
the eruption. Insomnia and restlessness, if excessive, are to be quieted 
by the bromides or chloral, care being taken that the doses of the 
latter are not large enough to depress the heart. It must be remem- 
bered that the time of onset of the secondary fever, the eighth day, 
is one of grave 'import to the patient. Before its arrival the treat- 
ment of the case must be so managed that strength is saved for this 
strain, and tincture of the chloride of iron, in 5- to 10- (0.3-0.65) or 
even 20-minim (1.3) doses, may be resorted to to give strength to the 
patient and to affect specifically the pyaemic fever. The pulse should 
be watched, and if it flags brandy and whiskey should be freely but 
wisely used. At the same time nourishment in the shape of eggnog, 
milk punch, or beef tea should be pushed as freely as the digestion 
will allow. 

The peripheral irritation and itching of the eruption are a cause of 
the fever in part, and produce much unrest and nervous irritability. 
The condition of the skin is, therefore, to be looked after, and the pit- 
ting prevented, if possible, by every means in our power, particular 
care being taken to prevent its development on the face. One of the 
means which has been recommended to prevent pitting is the use of 
flexible collodion, and another application is glycerite of starch or 
simple cerate applied in a heavy coating. Some physicians recommend 
inserting the tip of a nitrate-of-silver stick into each vesicle as it rup- 
tures, to prevent pitting. All of these measures are futile in most cases, 
and the use of collodion is probably harmful in some instances. The 
best application to use is made up of 4 parts of salicylic acid to 100 
parts of vaseline or cold cream. Sometimes, anointing the entire 
body with sweet oil slightly carbolized (1 : 100) is useful to check 
irritation. 



750 DISEASES. 

If the mouth is sore, a mouth-wash of chlorate of potassium and 
water may be used, flavored with a little tincture of myrrh. (See 
Chlorate of Potassium.) 

Disinfection, good ventilation, and the avoidance of much light 
are necessary. 

STINGS AND BITES. 

The stings of nearly all small insects depend for their activity 
upon formic acid, and are to be relieved by the use of dilute alkaline 
liquids, or, better still, by the application of ammonia, or, instead, 
an application of ordinary or flexible collodion may be made, or dis- 
tilled extract of witch hazel, w T hich is improved in its action by the 
addition of 1 part of mercury bichloride to 1000 of the collodion, or, 
if preferred, salicylic acid may be added in the proportion of 5 grains 
to the ounce (0.3 : 30.0). Sometimes a solution of carbolic acid, 1 : 100 
or 1 : 50, when sponged over the parts exposed, not only relieves the 
itching of mosquito-bites, but keeps away the mosquitoes. In other 
instances the stings are relieved and cooled by the use of dilute or 
pure vinegar. 

A useful application to prevent mosquitoes from biting is : 

R.— Olei citronellae f^j (4.0). 

Alcohol f^j (4.0).— M. 

S. — Apply freely to the skin exposed. 

In snake-bite the best treatment consists in sucking the wound, as 
snake-venom, even if swallowed, is not very poisonous. The part 
should then be freely incised, so as to cause the blood to flow freely, 
and immediately the wound should be filled with permanganate of 
potassium, and full doses of this drug given hypodermically about the 
wound, the salt being diluted three-fourths with water and followed by 
full doses of alcohol or ammonia by the mouth. The secret of success- 
ful treatment consists, however, in the use of a ligature above the bitten 
spot and the cleansing of the wound as soon after its reception as pos- 
sible, thereby preventing the absorption of the poison. 



STOMATITIS. 

This annoying affection is most commonly seen in children, and 
is characterized by the appearance on the tip and sides of the tongue, 
lips, and lining membrane of the mouth of small spots which some- 
times have a reddened zone around them, and which result in minute 
or large ulcers. 

The best treatment, if the kidneys are not acutely inflamed, is the 
use of the following prescription, which largely depends for its value 
upon the potassium salt used: 

R — Potassii chlorat 3J (4.Q). 

Tinct. myrrh gtL xx (1.3). 

Elixir calisaya . . f-iij (90.0).— M. 

S. — Teaspoonfal in water every four hours. 



STYES. 751 

As the chlorate of potassium is eliminated with the saliva, it not 
only does good when taken into the mouth, but is active all the time 
that it is being eliminated. If the stomach is disordered, the same 
preparation may be used as a mouth-wash. Often constipation will 
exist, and it should be removed by salines or by rhubarb in the form 
of the aromatic syrup. Another remedy which is very efficient in 
stomatitis is borax, used as a mouth-wash, in the strength of 10 to 15 
grains to 1 ounce (0.65-1.0 : 30.0) of water and honey, as follows: 

R— Sodii boratis gr. xxx (2.0). 

Mel. purificati fgiij (12.0). 

Aquse ; . . . q. s . ad f^iij (90.0).— M. 

S. — To be used on a swab or as a mouth- wash overy four hours. 

This also may be given internally to adults in the dose of a teaspoonful 
(4.0) every three hours. 

In many cases peroxide of hydrogen in the proportion of 1 ounce 
(30.0) of a 15-volume solution to 8 ounces (245.0) of water proves a 
valuable mouth-wash. 

If the liver is at fault and is torpid, nitromuriatic acid is useful, 
and when the spots do not readily yield to treatment they may be 
touched with the tip of a stick of silver nitrate, which treatment, 
while it is momentarily painful, is very efficacious. 

Nearly always with this disease in childhood there is considerable 
fever, vomiting, and wakefulness at night, with fretfulness and crying 
during the day, and total refusal of food, not because hunger is absent, 
but because the food hurts the mouth and is rejected with a cry of 
pain as soon as it touches the lips. The food should be very soft 
milk toast for older children, or milk with lime-water in it in large 
amount for infants fed by the bottle. If a child at the breast be 
attacked, the mother's nipple should be carefully washed with boric- 
acid solution after each nursing. A warm foot-bath at night is often 
necessary to produce rest, and 10 minims (0.65) of sweet spirit of nitre 
thoroughly diluted may be given with advantage to a child of one or 
two years. If the irritability of the nervous system is excessive, 
bromide of sodium or potassium in the dose of from 1 to 10 grains 
(0.05-0.65), according to age, three times a day, is of service, and 
may be added to the mixtures already named, or, better still, given 
alone, well diluted with syrup and water. 

After the attack tonics and a carefully selected diet are generally 
necessary. 

STYES. 

Styes consist in a localized inflammation of one of the glands in 
the margin of the lid or the surrounding connective tissue. Before 
suppuration is established abortive treatment may be practised by an 
inunction with a salve of the red or yellow oxide of mercury (2 grains 
to 1 ounce [0.1: 32.0]), by painting the surface with an ethereal 
solution of collodion, or, according to Abadie, by the application of a 
saturated solution of boric acid. Pain may be alleviated with hot 



752 DISEASES. 

compresses (water 110° F.), frequently changed, but as soon as pus 
appears incision is necessary. Associated conjunctivitis requires a 
boric-acid solution for its relief. It should be remembered that styes 
indicate ill health, that tonics are indicated, and that they most fre- 
quently appear in the subjects of refractive error. When they tend 
to come in crops the internal use of sulphurate of calcium has been 
recommended. 

SUNSTROKE. 

Sunstroke — or, more correctly speaking, heat-stroke — is an affec- 
tion produced by exposure of the body to any form of high tempera- 
ture, whether the source of heat be the sun, a furnace, or the radiation 
of heat from the earth. For this reason the condition may occur as 
readily at midnight as at mid-day. 

Heat-stroke is to be divided into two classes, in one of which 
excessive exposure to heat upsets the balance of the thermal mechanism 
of the body, so that fever comes on (thermic fever) ; in the other the 
temperature is lowered and forms the condition known as heat- 
exhaustion. 

The condition of thermic fever is very frequently seen, while heat- 
exhaustion is rare. 

The danger of thermic fever is that the excessive heat may cause 
coagulation of the myosin in the heart-muscle and of the protoplasm 
in the brain, and cause death, or that the same result may be reached 
by paralysis of respiration. 

The danger of heat-exhaustion is that death may ensue from col- 
lapse due to a general failure of vital power and the chilling of the 
body. In heat-exhaustion, too, the vascular system is greatly relaxed 
and depressed, and the circulation is at its lowest ebb. 

The treatment of these two states is, of course, radically different. 
When a patient has thermic fever and is brought under the care of 
the physician, the first thing to be done is to loosen the clothing — if 
possible, remove it — and if the pulse be bounding, the face cyanotic, 
and the heart laboring, to freely bleed him. At the same time intra- 
venous injection of normal salt solution should be freely resorted to, 
and this is particularly needful if the blood flows slowly and is very 
dark in hue. At the same time cold should be applied to the body, 
and particularly to the head, abdomen, back, and chest. The man 
should be stripped, laid upon a bed, which must be covered with a 
rubber blanket, and ice-water be applied to the body by means of a 
sponge, or a piece of ice may be laid on the head, while another piece 
is rubbed over the rest of the body. While this is being done the 
surface of the patient's body must be thoroughly and briskly rubbed 
in order to bring the hot blood to the cooled skin. 

Care should be taken that the temperature, when it once begins 
to fall, docs not drop suddenly below the normal and cause collapse. 
[f the clinical thermometer in the mouth or rectum shows that the 
temperature has fallen to 100. , r >° F. or 101° F., the cold implication 
should ho stopped, and the patient allowed to lie on the bed covered 



SYPHILIS.. 753 

only with a thin sheet. The bodily temperature must be constantly 
watched, as it will probably bound up again in a few minutes, and 
require the application of more cold, used with the same care. This 
second rise is due either to the disorder of the nervous mechanism of 
heat-production and dissipation, or to the fact that, while the surface 
of the body is cooled by the ice, the innermost viscera are still in high 
fever and rapidly heat the surface as soon as the ice is taken away. 
Antipyretics have been found to be almost useless in the hyperpyrexia 
of sunstroke, and are not to be relied upon. 

After the fever has been reduced permanently the danger is not all 
passed, and it is the greatest mistake to discharge a patient as cured 
at this time. After two or three days it is very common for a menin- 
gitis to develop, accompanied, it may be, by little or no fever, but 
characterized by violent darting headache, which is made worse on 
lying down or on sudden movement. The treatment of this state 
must be bold, and venesection is the only safe method of obtaining 
relief, although vascular sedatives, such as veratrum viride, may be 
employed. The bleeding should be copious enough to impress the 
circulatory system to some degree, and may be done by opening any 
of the prominent veins in the arm. (See Venesection.) Sometimes a 
violent attack of epistaxis saves the man's life, when it would have 
been lost through the ignorance of his attendant. If life is preserved 
without vascular depletion, secondary changes in the brain may ensue 
and produce hemianopsia, optic atrophy, imbecility, or insanity. 
Quinine, salicylic acid, and similar substances are all contraindicated 
under these circumstances, because of the congestion of the meninges 
to which they predispose by their physiological effcts. 

The treatment of heat-exhaustion consists in the use of heat instead 
of cold, in order to restore the bodily temperature. Just here, how- 
ever, must be uttered a word of warning — namely, that the mere fact 
that the skin is cold does not prove the case to be one of heat-exhaus- 
tion, since a rectal thermometer may show the central or real tem- 
perature of the body to be in a condition of hyperpyrexia. Of course 
such a case should not receive hot, but cold, rectal injections if the 
symptoms require it. 

The bodily heat in heat-exhaustion is to be raised by placing the 
patient in a bath at 105° to 110° F., or by the use of hot bricks or 
Dottles, care being taken that they do not burn the patient. The 
bodily temperature should also be watched, lest the other extreme of 
heat be reached. 

Cases of heat-exhaustion are not so apt to have meningitis as are 
cases of sunstroke, but they are generally slow to convalesce, and 
require tonics and careful watching for a long time. Indeed, in many 
instances the system seems to receive a shock from which it takes 
several weeks or months to recover. 

SYPHILIS. 

In so far as the choice of drugs is concerned, the treatment of 
syphilis is exceedingly simple : iodine, iodide of potassium, and mer- 

48 



754 DISEASES. 

cury practically represent the only remedial agents which are well 
proved to possess the power of distinctly counteracting the effects of 
the disease. 

In regard to the method of administration and the period of the 
disease in which any or all of these drugs can be given to the best 
advantage there is a wide diversity of opinion. Following the teach- 
ing of Fournier, in this country the practice generally obtains of 
administering mercury on the appearance of the first symptoms of 
the secondary stage of syphilis ; this drug is continued for from 
twelve to eighteen months, and is then followed by a course of iodide 
of potassium continued for from six to twelve months. If after the 
suspension of this treatment for six months no manifestations of dis- 
ease appear, the patient is regarded as cured. Should the disease 
again break out, the iodides are administered in increasing doses, sup- 
plemented by the addition of mercury if necessary. 

Against this treatment, however, there have been many and vigor- 
ous protests. Every syphilographer knows that the disease is fre- 
quently self-limited. Zeissl states that a large number of cases prog- 
ress to spontaneous cure, and that the secondary eruption in such 
cases disappears in from two to eight months, after which time the 
patient is perfectly well, recidivity being far less common than when 
mercury has been employed in the early stages of the disease. The 
treatment by iodides, he thinks, should be commended chiefly after 
the expectant plan : their effect is not so rapid as is that of mercury ; 
they are suitable, however, to all stages of the disease. When the 
symptoms become so urgent that it is no longer safe to depend upon 
iodides, mercurial inunctions should be employed, the dosage of the 
drug being regulated by its effect upon the symptoms, in all cases the 
minimum quantity necessary to accomplish the result being admin- 
istered. 

We have, then, three methods of treatment proposed, each advo- 
cated by a formidable array of authorities : 

1. The expectant treatment. 

2. The treatment by iodides, followed, if necessary, by mercury. 

3. The continued treatment, beginning with mercury and ending 
with iodides or the combination of the two drugs. 

By the expectant treatment is implied abstinence from all medica- 
tion intended to directly counteract the syphilitic virus : if possible 
the patient should lead an active, out-of-door life, the diet should be 
most carefully regulated, and the treatment should be purely symp- 
tomatic, tonics being administered when required, the sore throal 
being combated by astringent gargles, particularly those containing 
chlorate of potassium or malic acid, together with direct local appli- 
cations, while the eruption on the exposed parts of the body is con- 
trolled by the application of heat. Even in the mildest cases there 
is nothing to be said in favor of this treatment. Where the primary 
lesion is large and persistent; where the period of secondary incuba- 
tion is less than seven weeks; where the papular eruption is uni- 
versal, is confluent, and is accompanied by the simultaneous appear- 
ance of mucous patches; where the lymphatic enlargement is very 



SYPHILIS. 755 

marked and persistent ; and where the disease attacks a depraved con- 
stitution, — the expectant plan' offers little hope of accomplishing a 
cure. Here the second and third methods of treatment are absolutely 
indicated. 

By the second plan of treatment the iodides are administered, not 
immediately on the appearance of the secondary eruption, but after 
this has run a course of several weeks and is steadily increasing in 
severity. The iodide of potassium is chosen by preference, beginning 
with the administration of 5 grains (0.3) three times a day, and in- 
creasing steadily 5 grains (0.3) a day until either the constitutional 
effects of the drug are manifested or the symptoms are favorably 
influenced. Should iodism appear, the dose is cut down one-half 
and continued for one or two weeks, after which, if the syphilitic 
lesions are not favorably modified, inunctions of mercury are employed, 
a drachm (4.0) of mercurial ointment being rubbed in every other day. 
The iodide should be continued for from six to twelve months after 
the disappearance of all symptoms, relapses being combated by tem- 
porarily increasing the dose and by a course of mercurial inunctions. 
If after the suspension of the treatment the patient remains free 
from all manifestations of syphilis for two years, he can be fairly 
considered as cured. 

By the third method of treatment — and this is the method most 
commonly accepted in practice — the patient is placed upon mercury 
the moment the early secondary symptoms denote that the primary 
sore was surely syphilitic. Many surgeons begin this treatment from 
the time that the inguinal glands on both sides become characteristic 
in shape and size. Others wait until there is general lymphatic 
involvement, while others believe that the mercury should not be 
administered until roseola appears. 

In regard to the particular preparations of mercury to be em- 
ploved, the protiodide, blue mass, bichloride, and mercury with chalk 
represent the forms usually employed when the drug is administered 
by the stomach. Of these the protiodide is to be preferred, and the 
effort of the surgeon is directed first toward determining what is termed 
the "tonic" dose. With this end in view, \ grain (0.016) of the 
protiodide of mercury is given, in pill form, three times a day, and 
every second day this quantity is increased by one pill, the patient 
being meanwhile carefully watched. The drug usually manifests its 
physiological effects by griping pains accompanied by two or more 
watery passages from the bowels, or by foetid breath and slight ten- 
derness of the gums. The quantity taken to produce this effect 
represents the extreme limit to which it is safe to push the drug. If 
this dose is continued or increased, the characteristic symptoms of 
mercuric saturation appear. When the surgeon has determined the 
limit to which the drug can be safely pushed, this dose is cut down 
one-half, and in the absence of further complications the patient is 
directed to continue with this dose for eighteen months. If during 
this time local symptoms appear which show that the disease is not 
thoroughly under control, the mercury must again be pushed to the 
full dose, being reduced to the tonic dose as soon as the disappearance 



756 DISEASES. 

of specific lesions permits of this. Where comparatively small doses 
of the protiodide produce pain and purging, opium may be added ; in 
this case the breath and the mouth will show when the full effect of 
the medicine is obtained. Manifestations of the disease occurring 
during mercuric treatment must receive local treatment. The surface 
eruption is combated by mercuric ointments and washes and by the 
application of heat. (See Heat.) Mucous patches in the mouth are 
quickly healed by applications of solid nitrate of silver or sulphate 
of copper, 20 per cent, chromic-acid solution, or the acid nitrate of 
mercury. When these patches occur about the genitals, washing with 
1 : 2000 bichloride solution and dusting with calomel and bismuth 
will be found satisfactory. Alopecia is combated by shampooing and 
by the application of strong stimulating lotions containing croton oil 
or tincture of cantharides. 

The intense cephalalgia is combated by -J-grain (0.010) doses of 
calomel, repeated overy two hours. The periostitis yields most read- 
ily to gentle, long-continued mercuric inunction, supplemented by the 
application of pressure bandages. 

When the integrity of any vital organ is threatened there should 
be no hesitation in pushing the mercury treatment, and in supple- 
menting it, if favorable results do not follow promptly, by large doses 
of iodide of potassium. 

After the first eighteen months iodide of potassium is generally 
indicated. This is commonly given together with the mercury, con- 
stituting the mixed treatment. The following formula, or one similar 
to it, may be employed : 

R.— Potassii iodidi ^ij vel ^iv (8.0-16.0). 

Hydrarg. chlor. corros gr. ss (0.03). 

Syrup, aurant. cort . f5j (30.0). 

Aquae q. s. ad %ij (60.0).— M. 

S. — Teaspoonful (4.0) three times a day. 

When this prescription is put up a precipitate is formed and then 
dissolved. . 

This mixture, or iodide of potassium without the mercury, admin- 
istered in 5- to 10-grain (0.3-0.65) doses three times a day, is given 
for from six to twelve months longer. When the iodide is given alone 
it is most conveniently administered in the form of a saturated solu- 
tion. Of this a drop contains a grain of the salt. Milk seems to 
have the power of completely disguising the disagreeable taste of the 
drug. Thereafter, specific treatment is stopped, unless symptoms 
arise, in which case it should be renewed and should be continued for 
many months. 

The protiodide is usually preferred, because the symptoms of its 
constitutional effect are manifest at first by looseness of the bowels, 
and because in practice it has been found one of the most satisfactory 
of all preparations. Where this form of mercury is not well borne 
the physician should at once employ some other salt; the bichloride, 
in ^j-grain (0.005) doses three times a day, is efficacious. Blue mass 
will often act favorably when other preparations cannot be tolerated. 



SYPHILIS. 757 

Its combination with iron is desirable, and the following formula rep- 
resents one of the most valuable of the antisyphilitic pills : 

R. — Mass. hydrargyri gr. xxx (2.0). 

Pulv. ferri chloridi gr. xv (1.0). — M. 

Ft. in pil. No. xii. 
S. — One three times a day. 

Where mercury cannot be administered by the mouth it may be 
given by means of vapor-baths, by inunctions, and by hypodermic 
injections. The vapor-baths are useful when it is desired to promptly 
cure eruptions on the surface of the body or when it is most import- 
ant to bring the disease quickly under the influence of mercury. 
They are readily administered, the only apparatus required being an 
alcohol lamp and a plate in which the mercuric preparation can be 
volatilized. The patient is seated in a chair entirely naked; several 
blankets are wrapped around his neck, and beneath the tent thus 
formed a large vessel of steaming water is placed. When the skin 
is thoroughly softened J drachm (2.0) of calomel is sublimed by 
means of the lamp. These baths may be repeated every night until 
the mercuric foetor of the breath is observed or until the specific 
symptoms disappear. (See articles on Mercury and on Heat.) 

Inunction represents the most efficient way of administering the 
mercuric treatment. When the stomach is intolerant of drugs, or 
when, administered by the mouth in full doses, they do not favorably 
modify the symptoms, inunctions are indicated. The patient is 
instructed to take a warm bath, and the mercury is then well rubbed 
in over the inner surface of the forearm and arm and along the side 
of the chest for fifteen minutes. Either the oleate of mercury, 10 
per cent., or the ordinary mercury ointment is commonly employed; 
the former is more cleanly, but less efficient. The rubbings should 
be done by the patient, should be made over a large surface of the 
body, and should be performed thoroughly; 1 drachm (4.0) of blue 
ointment is rubbed in daily. A shirt kept for this purpose is then 
put on next to the skin, and the ordinary clothing is worn over this. 
The next night the opposite arm and side of the body are utilized as 
the seat of inunction ; the following night the right groin and the 
inner surface of the right thigh and leg ; next, the same regions of 
the opposite side of the body ; finally, the anterior surface of the 
chest and abdomen. In this way irritation of the skin is avoided. 
Where it is impossible to employ the inunctions in this way, another 
means of causing absorption of mercury through the skin, suggested 
by Sturgis, will be found satisfactory : After a thorough soaking of 
the patient's feet in hot water, from J to 1 drachm (2.0-4.0) of a 20 
per cent, oleate of mercury is rubbed vigorously into the sole of one 
foot ; the next night the sole of the other foot is treated in the same 
way. The patient is directed to wear, night and day, a pair of wool- 
len socks ; these are not changed for one week. Mercury may be 
taken by the mouth at the same time inunctions are employed when 
it is desired to influence the system quickly. In the late periods of 
the disease very striking effects are often obtained by supplementing 
the iodide treatment by a course of twelve to eighteen inunctions. 



758 DISEASES. 

The hypodermic administration of mercury is in this country lim- 
ited to those few cases which do not seem to respond to the drug 
when given by the mouth or by inunction. Although many prepara- 
tions of mercury have been lauded as most efficacious when used hypo- 
dermically, the best formula seems to be that recommended by Hebra. 
This consists of a solution of 1 per cent, of bichloride of mercury in 
a 6 per cent, sodium-chloride solution ; the resulting mixture is per- 
fectly clear and is readily prepared. If it becomes turbid it should 
be thrown away. Most rigid antiseptic precautions must be observed, 
as abscess-formation is not uncommon. One injection is given daily, 
from i to J grain (0.01-0.02) of the sublimate being administered. 
The nates are selected as the seat of the injection, the solution being 
driven well into the muscles of each side every other day. Twenty 
injections are usually sufficient to cause the disappearance of all symp- 
toms. The employment of the insoluble preparations of mercury, 
particularly of calomel, gives much pain, frequently causes abscess, 
and is at times attended by a continuous absorption which may pro- 
duce severe and even fatal ptyalism. 

The ulcerations often found as tertiary manifestations of syphilis 
are treated according to general surgical principles. The local 
application of mercuric preparations is of less service than during 
the existence of the secondary lesions. Iodoform is peculiarly ser- 
viceable. 

The tonic and general treatment of syphilitic cases must not be 
forgotten ; fresh air, exercise, bathing, careful diet, regular living, all 
must be enjoined. Moreover, in certain cases where there is marked 
anaemia or physical weakness cod-liver oil, stimulants in moderation, 
compound syrup of the hypophosphites, and other tonic and nutritive 
courses of treatment must be carefully administered. 

Although the treatment of an ordinary case of syphilis is simple 
and satisfactory in its results, it must be remembered that there are 
malignant forms of the disease, attacking by preference feeble and 
cachectic individuals, running a rapid and virulent course, unchecked, 
nay aggravated, by specific treatment, and responding feebly, if at all, 
to the most careful hygienic and tonic regimen. In such cases a 
strong extract of sarsaparilla is sometimes of service. 



TETANUS. 

The treatment of tetanus is quite independent of its causation, 
so far at least as drugs are concerned, and is virtually identical with 
that of Strychnine Poisoning, to which the reader is referred. (See 
Nnx Vomica.) It is stated that Fowler's solution acts almost as a 
specific; in some cases. The value of the antitoxin for tetanus depend! 
very largely upon how early it is given. When the disease has once 
developed, it naturally cannot be of much use, but it should always 
be tried. (See Antitoxin, Part III.) The diet should be most nour- 
ishing. Continuous immersion in hot water may be tried. 



TONSILLITIS— TUBERCULOSIS. 759 



TONSILLITIS. 

Inflammation of the tonsils occurs in three forms : superficial 
tonsillitis, in which the mucous membrane covering the tonsils becomes 
inflamed through extension of a pharyngitis ; follicular tonsillitis, in 
which the follicles are chiefly involved and pour out an excessive 
secretion ; and, finally, true tonsillitis, in which the gland itself 
suffers from severe, widespread inflammation phlegmonous in type. 
In all these forms the treatment to be instituted at the beginning is 
practically identical. The bowels should be opened by a saline pur- 
gative, which in some cases should be preceded by small doses of 
calomel, the diet should be liquid and nutritious, and a fever and 
diuretic mixture should be given freely as follows : 

R. — Tine, aconiti Ti^xij vel xxiv (1.0-1.6). 

Spt. aetheris nitros f^j (30.0). 

Liq. potassii citratis . . . q. s. ad f^iij (90.0). — M. 
S. — Dessertspoonful every three hours. 

Locally, a very useful treatment is to paint the tonsil with pure 
guaiacol on a cotton applicator, or we may use a solution of nitrate of 
silver, 60 grains to the ounce (4.0 : 30.0), applied with a camel's-hair 
brush. Externally, an ice-bag should be applied about the throat, 
and as soon as the purgative has acted and the fever is reduced by the 
mixture just given, full doses of the tincture of the chloride of iron 
should be administered (20 minims [1.3] every three or four hours), 
in plenty of water, which preferably should be Yichy or one of the 
good lithia waters. 

Small doses of biniodide of mercury are sometimes useful to abort 
an attack of acute tonsillitis. 

In inflammatory involvement of the entire tonsil active scarifica- 
tion in the early stages may be of service in limiting the severity of 
the attack. In some instances hot fomentations about the neck and 
hot gargles seem to be more beneficial than the use of ice. Often a 
mild antiseptic gargle of carbolic acid (1 : 100 of water) will relieve 
the pain and the foetor of the breath. 

Finally, it should be remembered that rheumatic persons suffer 
severely at times from tonsillitis, and the best remedies for this form 
of tonsillitis are the salicylates or guaiac. 

TUBERCULOSIS. 

Under this head will be considered pulmonary tuberculosis as a 
type of all forms of this morbid process. Its treatment may be 
placed in two lines — the first devoted to the cure of the disposition 
or inclination toward the disease or the abortion of its early stages ; 
the second directed to the improvement of the patient's condition, so 
that his progress through the disease may be made as comfortable as 
possible. Before doing this, however, it is proper to state that pro- 
phylaxis, or true prevention, is the object really to be sought after. 
Again it is certainly true that many cases of early tuberculosis are 



760 DISEASES. 

curable. Recent studies have shown most conclusively that tubercu- 
losis is capable of being transmitted from man to man if air laden 
with the bacilli is breathed, and if the lungs are in a fit state of 
depressed vitality, from any cause, to afford a favorable field for the 
growth of the germ and the development of its poison. 

Cases of pulmonary consumption follow, rudely speaking, four 
well-defined lines. A very early stage sometimes comes to the care 
of the physician, and it is that in which the following history is given 
or a similar story is elicited. A patient, previously strong and well 
or of poor health, as the case may be, begins to lose vivacity. Life 
becomes a burden and exercise is distasteful. A slight daily chill, in 
morning or evening, and fever develop, and the physician who is care- 
less treats the case as one of mild malarial poisoning. Careful exam- 
ination, however, will show an area in the lung, generally near the 
apex on one or both sides, where slight prolongation of expiration 
with a harsh inspiratory sound is heard, and where percussion will 
give impaired resonance or dulness. In other words, the first stage 
of phthisis is present, and the physician must resort at once to those 
active measures for the patient's relief which will be considered in a 
moment. 

In another form a chill, a sweat, a loss of flesh and vigor, with, 
more prominent than all, a hard cough, sudden in its onset and rap- 
idly becoming excessive with profuse expectoration, are the dominant 
symptoms. The wasting is extraordinary, the sweats are constant, 
and death may come in a few weeks. This is the form known as 
"galloping consumption." 

The third variety is ushered in by a gradual loss of vigor or a sen- 
sation of being a little unwell, or is brought before the patient's mind 
by a sudden acute hemorrhage, or several hemorrhages rapidly suc- 
ceeding one another. This variety passes along its course more or less 
rapidly. Sometimes death soon ensues from a fatal hemorrhage ; in 
other cases the disease keeps on for months and the case dies from 
exhaustion. 

Last of all, the fourth class is made up of persons who gradually 
pass from bad to worse: First, they "catch a cold," which hangs on 
longer than it ought, and, as soon as they are well, this is followed by 
another one, which is found more difficult to cure, until finally there 
is always a cough. Soon wasting comes on, strength is lost, and a 
long period of months or years ensues during which the progress 
of the case is now slow, now fast, the condition now better, now 
worse, until death ensues from wasting, pneumonia, or some other com- 
plication. 

These forms and stages have been roughly outlined, so that a dis- 
cussion of their treatment might be taken up with a clear idea of 
what is to be done. 

When a patient exhibits those physical signs which have been 
given as evidences of the early beginnings of phthisis, the physician 
should institute certain hygienic and medicinal measures. If the 
individual be earning a livelihood by following some confining occu- 
pation, this occupation must be given up and one undertaken which 






TUBERCULOSIS. 761 

is carried on in the open air and yet not accompanied by too great 
exposure. Even if exposure is incurred, it is better than the occu- 
pation previously followed : thus, if the patient be a bookkeeper, a 
printer, or a bookbinder, or a clerk kept much at a desk in an ill- 
ventilated room, a few wettings in the rain will do little or no harm 
if the patient is properly protected by the wearing of flannel shirts, 
which, when wet, are changed as soon as labor ceases, as under these 
circumstances the danger of catching cold is at a minimum. (See Part 
IIL, article on Climate.) 

The medicinal measures to be carried out in all cases of phthisis, 
except that known as the galloping form, are not numerous if w T e 
confine ourselves to the modes possessing any real value. For many 
years cod-liver oil has been sadly abused in the management of these 
cases, and has been given at all stages, owing to ignorance of its 
proper use as a general rule. The writer believes that the following 
rules are never to be departed from : 

1. Never use cod-liver oil if it disturbs digestion. 

2. Never use it if fever is active. 

3. The use of cod-liver oil when rapid degenerative changes are 
occurring in the lung may be distinctly harmful, as it is not of any 
service, disorders the digestion, and destroys the appetite. 

4. Its best employment is in chronic fibroid phthisis. 

When the oil is used it should be given as directed in the article 
on Cod-liver Oil. 

A remedy of great value as a palliative is creosote, first introduced 
by Bouchard. Many cures have been claimed from its use in the early 
stages of phthisis, and it has been highly lauded by a number of 
European clinicians. In the author's experience it is merely a pallia- 
tive to the cough and general discomfort, particularly when the disease 
is fully established ; and the opinion expressed by Striimpell expresses 
so well the thought which the author was about to write when he read 
StrumpeH's article that his words are here given : " Taking it all in 
all, we find that creosote, even in large doses, has no injurious effect on 
tuberculosis. At times we notice an apparently favorable symptomatic 
effect. We failed, however, to observe any real influence exerted by 
creosote on the progress of the disease." 

On the other hand, the relief of some distressing symptoms by creo- 
sote is never to be underrated. (See Creosote.) 

When creosote is used internally it may be given in the following 
formula : 

R. — Creosoti (beecLwood) gtt. xxxij vel f^j (4.0). 

Tr. gentian. f^j (4.0). ' 

Alcoholis f,lj (30.0). 

Vin. albse q. s. ad f^iv (120.0).— M. 

S. — Teaspoonful (4.0), in water or wine, three times a day. 

Better still, it may be given in ascending doses (1 minim extra each 
dose) in milk or wine. 

Often a 1-minim (0.05) dose three times a day may be increased to 
5 minims (0.3) in the same period with advantage, and if given in 
ascending doses the author has frequently had patients take as much 



762 DISEASES. 

as 90 minims (6.0) a day. Sometimes 1 or 2 minims (0.1) in capsules 
are as useful as the formula just named. (For methods of adminis- 
tration see Creosote ; also, see Gruaiacol and Creosote Carbonate.) 

Creosote may also be inhaled in the spray from a steam atomizer 
or by means of an inspirator fitted over the nose and mouth and 
made of perforated zinc with a sponge at the edge to hold the drug. 
A very good method is to wet the sponge with creosote, alcohol, 
and water, equal parts, or to use the creosote alone if coughing is not 
too severe. Another useful mixture consists of equal parts of tere- 
bene, iodide of ethyl, and chloroform. This last mixture is most 
useful when the secretion is tough and tenacious, and should not be 
used in the presence of acute irritation due to inflammation. Such 
inhalers are very cheap, not easily broken, and readily worn. 

If the cough in phthisis is excessive, a little spirit of chloroform 
placed on the sponge of the inhaler will often relieve it, or a mixture 
of morphine and wild-cherry bark may be given as follows : 

R. — Morphinre sulph. , gr. j vel ij (0.05-0.1). 

Syr. pruni Virginianse f^iij (90.0). — M. 

S. — Teaspoonful (4.0) every three hours. 

Or the following : 

R.— Spt. chloroformi fgss (15.0). 

Morphinae sulph gr. j vel ij (0.05-0.1). 

Syr. pruni Yirginianae f 3 iij (90.0).— M. 

S. — Teaspoonful (4.0) every four hours. 

In still other cases 2 to 10 minims (0.1-0.65) of a good fluid 
extract of cannabis indica, or -J- to \ grain (0.008-0.016) of the solid 
extract, will act with surprising benefit and stop the cough. Heroin 
in small doses is also useful. 

Aery often during the course of phthisis localized spots of pleu- 
ritic inflammation arise. Without the occurrence of any exposure 
the patient will remark, " Doctor, I think I have taken a little more 
cold, and I have a stitch here in the chest." The best treatment is 
to apply a small blister or to paint the spot with iodine. 

(For the treatment of Haemoptysis see Hemorrhage.) 

Laryngeal phthisis, one of the most serious complications of this 
disease, is best prevented by ordering the patient to inhale the steam 
arising from boiling water which contains corrosive sublimate in the 
proportion of 1 : 10,000. If a proper watch is kept for evidences of 
a general mercurial effect, and this measure stopped at once when 
tenderness of the gums appears, no danger exists. Before the inhala- 
tion takes place a spray of cocaine (4 per cent, solution) should be 
thoroughly used. 

The treatment of laryngeal phthisis itself is various. The best 
method is that in which lactic acid is used. By the aid of a laryn- 
geal mirror and a cotton applicator a 10 per cent, solution of lactic 
acid is applied to the spots which are involved. As this is generally 
quite painful, cocaine solution should first be used. Gradually the 
Strength of the lactic-acid solution should be increased to 60 per cent. 



TYPHOID FEVER. 763 

if the weaker solutions do not check the disease. Very valuable 
results have been obtained by this method. 

The second method in point of value is that of iodoform insuffla- 
tions. A powder of iodoform alone is too light for satisfactory pro- 
pulsion into the larynx, and powdered talc should be added to it in 
small amount, as may also y 1 ^- grain (0.004) of morphine to each 
drachm (4.0) of iodoform. The odor is generally disagreeable to 
the patient, but if a cocaine spray be first employed and the operator 
is skilful, very little coughing is produced. As iodoform is a local 
anaesthetic, it relieves the pain in the larynx, acts as an antiseptic 
and alterative, and is peculiarly obnoxious to the bacillus tuber- 
culosis. 

When the night-sweats are very profuse, hypodermic injections of 
atropine in the dose of yi-g- to yj-g- grain (0.0004-0.0006) are useful in 
some cases, and the efficiency of this treatment may be increased by 
the use of an alum sponge-bath at bedtime. A solution of alum, 10 
to 20 grains to the ounce (0.65-1.3 : 30.0), may be sponged over the 
body, or sulphuric acid maybe added to water in the proportion of 1 
drachm to the pint (4.0 : 500 cc), and used in the same way as the 
alum solution. 

Camphoric acid in 20- to 30-grain (1.3-2.0) doses is the best rem- 
edy and is invaluable in treating night-sweats. 

Sulphuric acid is often given internally with advantage in these 
cases of sweating. Small doses of pilocarpine amounting to -^V £ ra in 
(0.003), given from one to two hours before the sweat is expected, 
are sometimes potent for good. The means by which this result is 
brought about are not far to seek. The drug in any dose causes stim- 
ulation of the peripheral ends of the nerves supplying the sweat- 
glands. In many instances we find excessive secretion dependent 
upon depression of function, as in a serous diarrhoea or a local sweat- 
ing of the feet. These states pass away just as soon as the parts 
regain their normal tone through proper treatment. The night-sweats 
of phthisis are sometimes improved by pilocarpine, because this drug 
in all doses stimulates the sweat-glands. In large doses this stimula- 
tion amounts to free diaphoresis; but in the minute doses, such as -^ 
to -^ of a grain (0.0016-0.003), the stimulation just balances the de- 
pression and a normal tone is acquired. While it is true that pilocar- 
pine and atropine are physiological antagonists, it will be found prac- 
tically beneficial to prescribe small doses of both in such cases as refuse 
to respond to either one alone, as by their antagonism they prevent 
over-action on other parts of the body, and both act in harmony in 
so influencing the sweat-glands as to be of service to the patient. 

TYPHOID FEVER. 

Any attempt to review the various forms of treatment of the disease 
known as typhoid fever is absolutely impossible, owing to the very 
numerous theories and practices put forward by various clinicians. 
What is said under the general heading of Fever and under the con- 
sideration of Cold, Part III, and also under Antipyrin and Acetan- 



764 DISEASES. 

ilid, gives sufficient information as to the treatment of febrile move- 
ments, and the care of the patient beyond this point in nearly all 
cases depends upon the severity of the attack. 

Before going further, however, the writer desires to insist very 
strongly upon one fact — namely, that a case of typhoid fever is not 
curable in any degree. No remedy yet found, except it act through 
the prevention of complications, can shorten its course. We can only 
guide the patient safely to health when the storm of disease comes on, 
and we cannot stop the storm. 

Not only should the facts of the last paragraph be carefully borne 
in mind, but the physician must remember that he is treating an 
exhausting disease — not a disease which runs a violent course for a 
few days and strands the patient sick and weak, but convalescent, 
upon the shores of health, but one in which, after sapping the 
strength for weeks, some sudden intercurrent malady or accident 
may ensue which will speedily kill him if every grain of strength 
is not preserved for the struggle. The physician should always put 
every case in which there is a suspicion of typhoid fever to bed at 
once, and keep the patient there till the disease has passed or fails to 
appear. Every muscular movement unnecessarily made is a waste of 
force, and, in consequence, everything should be done for the patient, 
and not by him. A bed-pan should always be employed, the patient 
not being allowed to sit erect upon a commode. Remembering, too, 
that a typhoid fever patient is subjected to prolonged wasting fever 
and toxgemia for many days, his nutrition should be maintained by 
the use of a concentrated nourishing diet easy of digestion. In addi- 
tion to milk he should also receive one or two very slightly boiled eggs 
each day, arrowroot and perhaps thin corn starch, provided they agree 
with his digestive powers. If diarrhoea is not present, broths may 
be given, but it must be recalled that Brieger has shown that typhoid 
bacilli do not readily reproduce themselves and their poisons in pep- 
tone and well-digested milk, but do so very actively in meat-broths or 
jelly which has not been acted upon by the digestive juices. Milk 
diet is therefore evidently better than a broth diet in typhoid fever, 
and we once more are able to explain an empirical fact by a scientific 
discovery. Another reason for using liquid instead of solid foods, 
beyond the difficulty of digesting the latter, is the faet that solids 
may irritate or perforate the ulcers in the small intestines. 

Alcohol may be used in all stages as a stimulant, as a giver of 
force to the system, and as an aid to digestion. A very large part of 
the profession believe that the mere presence of an abnormally high 
temperature contraindicates the use of alcohol. Mere high tempera- 
ture does not do so, however, and it seems probable that many deaths 
have resulted from putting into practice such a belief. High tem- 
perature of a sthenic type, with a full, tense, bounding pulse and 
all the signs of a disease attacking one in the full vigor of life, 
of course precludes its use; but in the high temperature of advanced 
typhoid, with the marked asthenia often present in that stage, alco- 
hol should be given whenever the heart-sounds are feeble. Under 
these circumstances the tissues which the man can afford to lose are 



TYPHOID FEVER. 765 

gone, and much of his vitality is greatly encroached upon : the alcohol 
yields force to the body, and is burnt up in great part, keeping the 
flagging heart pumping the tides of blood through the lungs and sys- 
temic circulation, when otherwise the very cardiac depression would 
produce hypostatic congestion, if not more widespread circulatory 
disorder. 

A no less useful and valuable result obtained by the use of alcohol 
in the early stages of exhaustive fevers is the part that it plays in aid- 
ing digestion. The writer has elsewhere defined the difference be- 
tween the influence of alcohol in the artificial digestion of the test- 
tube and that occurring in the stomach. No one doubts that alcohol 
added to a small amount of gastric juice in the test-tube retards or 
prevents its action; but evidence is abundant to prove that the inges- 
tion of this drug produces by its stimulating and irritant action a very 
decided increase in the quantity of gastric juice secreted over and 
above the amount normally present. Aside from experimental evi- 
dence, every-day experience has taught the gourmand that alcohol, 
in a fairly concentrated form, enables him to digest an amount of 
food which under ordinary circumstances would remain unchanged in 
his stomach. 

The importance of aiding the flagging powers of the stomach is 
not generally recognized ; but if one remembers the fact that at one 
time during the course of a severe attack of typhoid an occasion may 
come when a struggle between the few remaining grains of strength 
and the disease results in death or in recovery, its importance becomes 
evident. By the ingestion and digestion of more food early in the 
attack a larger amount of vital force remains for use at a crisis, and 
the chances of a recovery, to say the least, are increased. Alcohol 
may therefore be used all through the ordinary exhausting fevers — 
for the purpose in the first stage of aiding digestion, and in the later 
stages of supporting the system ; but the physician ought not to use it 
as a routine measure in every case without a rational idea of why he 
does so, nor without a clear idea as to what indication is met by its use. 
In many cases it is not needed at any time. 

In those cases in which a temporary loss of heart-power is due to 
hemorrhage or to some sudden severe depression alcohol is one of the 
remedies to be employed — in a hot and concentrated form. 

That alcohol may be misused and cause great harm is, of course, 
known to every practitioner of medicine. So long as it reduces the 
temperature and lowers the rate of the pulse, causes a moist skin and 
tongue, and quiets nervous twitchings, it does good, and only up to 
this point is it to be employed. If its administration is pushed after 
this, the tendency to adynamia becomes, under the over-use of the 
drug, one of dynamia ; the pulse is no longer soft, but comes in 
angry, bounding beats; the nervous symptoms change from low, 
weak, muttering delirium to talkative delirium and restlessness ; and 
when the influence of the alcohol begins to decrease, and even before 
this time, the system has put forth the strength of days in a few hours, 
and the man, having no reserve strength, is in a dangerously feeble 
state. 



766 DISEASES. 

The treatment which has been used by the author in his wards at 
the Jefferson Medical College Hospital has given him results which 
the application of other methods has failed to give, and is as follows: 

As soon as the patient enters the house he is washed or bathed and 
placed in bed, and required to remain there. He is assured that the 
more quietly he lies the more mild and safe will be the course of his 
attack, and is made to use a bed-pan and urinal, and never allowed to 
get up. He receives several small doses of calomel, followed, if the 
bowels are not moved, by a mild saline purge, such as a Seidlitz powder. 
He is also given 5 drops (0.3) of dilute hydrochloric acid in a wineglass 
(32.0) of water every four hours, or, if the bowels are not active, nitro- 
muriatic acid is substituted therefor, care being taken to employ 1, 2, 
or 3 drops of the strong, freshly mixed acid according to the degree 
of coating of the tongue. The diet is largely a milk diet — namely, a 
quart to a quart and a half (1 to 1-| litres) a day, with a little salt to 
flavor it, as already described in the article on Indigestion. In some 
cases koumyss acts very much better than milk. Sometimes, if vom- 
iting is threatened, lime-water is added, or the milk is peptonized, or 
beef-tea is temporarily employed. In other instances the milk agrees 
with the patient if it is partly diluted with plain soda water or Apol- 
linaris water. Eggs, arrow T root, corn starch, and curds and whey are 
also allowed, as already indicated. 

For the dry and sordes-covered tongue a mouth-wash of glycerin 
and water, half and half, to which may be added a little lemon-juice, 
is used, and it is important to keep the mouth constantly cleansed, as 
by this means swallowing is not interfered with through cracking of 
the lips, tongue, and buccal mucous membrane, pulmonary infection is 
avoided, and facial erysipelas and parotitis are prevented. 

If constipation is very obstinate and continues over two days, an 
injection is employed, and if this, after being used twice, fails to act, 
a dose of calomel, -^ grain (0.001) every fifteen minutes till a grain 
has been taken, is prescribed, and, if no movement occurs in twelve 
hours, is followed by \ an ounce of sulphate of magnesium, or a tea- 
spoonful of liquorice powder is given. In other cases small doses of 
cascara sagrada are equally useful. Violent purgatives should never 
be used for obvious reasons. Rectal injections should be given some 
hours after the purgative is taken, to aid its action, since not infre- 
quently the laxative causes the contents of the small intestine to flow 
into the large bowel, Avhich is too inactive to extrude them. 

AVhen diarrhoea becomes troublesome — that is, over three or four 
passages a day — the following will be of service : 

R. — Acid, sulph. aromat f^ij (8.0). 

Extract, haematoxyli fl fsjiij* (12.0). 

Syr. zingiberis f^iij (90.0). — M. 

S. — Teaspoonful (4.0) in water every hour until relieved. 

Should the stools be excessively foetid and tympanites be marked 
guaiacol carbonate may be given as an intestinal antiseptic, or, so soon 
as any evidence of tympanites or much metcorism comes on, turpentine 
may be given, as follows: 



TYPHOID FEVER, 767 

R .— 01. terebinthinse f^ij (8.0). 

Syr. acacise . q. s. ad ffiij (90.0). — M. 

Ft. in emulsio. 
S. — Teaspoonful (4.0) three times a day. 

At the same time it is well to employ a turpentine stupe over the 
abdomen. (See Turpentine.) Where the tympanites is excessive it 
may be relieved by an injection made up as follows : 

R.— 01. terebinthinse f^j to ij (4.0-8.0). 

01. olivge f|iv (120.0). 

Emul. asafoetida? Oj (500 cc.). — M. 

S. — Use as an injection. Shake well before using. 

In the later stages of typhoid fever, as convalescence is approached, 
turpentine is often useful, as it causes rapid healing of the intestinal 
ulcers and stops diarrhoea. 

Much has been said about the value of purgatives and so-called 
intestinal antiseptics in typhoid fever, and extravagant claims made 
for them. Suffice it to state that while they may be indicated in 
certain cases they are not to be used as a routine plan of treatment, 
because the skill of the true physician is to give each patient what he 
needs — not to give all the same treatment. Typhoid fever cannot be 
aborted ; it can only be modified in the sense that we place our patients 
in the best possible physical state to withstand its ravages. 

A point of importance in the treatment of typhoid fever is to see 
that the patient receives enough water in twenty-four hours. Owing 
to his apathy he often does not complain of thirst and the kidneys are 
not flushed of impurities by fluid. Some perfectly pure water, such as 
Londonderry Lithia, or Poland water, should be freely given to help elim- 
inate toxic materials through the kidneys. Should toxaemia or emacia- 
tion be marked, it is wise to employ hypodermoclysis. (See Part III.) 

The complications of typhoid fever of the most serious import are 
hemorrhage from the bowel, pneumonia and pleurisy, and perforation 
of the bowel. 

The hemorrhage from the bowel may be treated as indicated under 
that heading (Hemorrhage), and the pneumonia or pleurisy should 
be treated as are these diseases when they occur alone ; but it is to 
be remembered that the patient is an asthenic adynamic case, and 
must not be depressed, but stimulated. When perforation of the 
intestine occurs, sufficiently large doses of morphine should be given 
to relieve pain, prevent collapse, and allay irritation. Warm appli- 
cations, should be used over the belly and down the limbs, and stim- 
ulants given if needed. In all cases where it is possible to find a 
surgeon capable of doing a skilful abdominal section a consultation 
should be had at once. If shock is not present, operation should be 
performed immediately, the perforation or perforations found, closed, 
and the peritoneal cavity well flushed with warm normal saline solution, 
to cleanse it of extravasated intestinal contents. If shock is present, 
operation should be delayed until it is overcome and then be per- 
formed. 1 (See Shock.) 

1 For discussion of this condition see the author's work on "The Medical Compli- 
cations and Sequelge of Typhoid Fever." Lea Brothers & Co., Philadelphia, 1899. 



768 DISEASES. 

As stated at the beginning of this article, cold bathing is very 
important and should always be employed in one of its forms if the 
fever is high, except in the presence of hemorrhage or perforation. 

For a number of days after the patient begs hard for solid food it 
should not be allowed, for he will ask for it long before he should 
have it ; but if the temperature remains normal after five days, very 
soft-boiled rice may be given with milk. The soft part of stewed 
oysters may be used and the patient gradually brought back to an 
ordinary simple diet. 



URAEMIA. 

The treatment of this dangerous manifestation of renal disease is 
often futile, but always to be resorted to with the recollection that 
wonderful recoveries sometimes occur under judicious management. 
It matters little whether the onset of the symptoms has been gradual 
or instantaneous : in either event the prime endeavor must be to rid 
the system of the poison which is threatening life. This can only 
be accomplished by aiding its elimination through the bowels, skin, 
and kidneys. The second indication is to support the vital organs 
until the emunctories have had time to act. Often this second indi- 
cation will be more pressing than the first, and the physician will 
have to give stimulants at once. The third indication is to arrest any 
convulsive seizures. 

The methods to be resorted to for the elimination of the urseruic 
poison are external and internal, externally the hot pack being 
resorted to to increase the activity of the skin. (See Heat, in Part III.) 
Internally we give elaterium or elaterin in the dose of ^ grain (0.01) 
or T L- grain (0.004), respectively, for the induction of watery purg- 
ing, which at once aids elimination through the bowel and relieves 
dropsy if present. The elaterin should be dissolved in a few drops 
of alcohol or in whiskey. The medication directed to increased action 
of the skin should consist of small doses, hypodermically — say -|- grain 
(0.01) — of hydrochlorate of pilocarpine, but this is contraindicatcd 
unless the heart is believed to be strong and acting properly. It may 
be used in conjunction with the hot-pack or hot-air bath. If dropsy 
is present, the drug will have to be given by the mouth, as it will not 
be absorbed from the dropsical subcutaneous tissues. Pilocarpine will 
also tend to increase the activity of the kidneys, and in addition to 
this influence on the renal structure we may use caffeine in the dose of 
2 grains (0.1) every four hours for three doses, to stimulate the renal 
epithelium still remaining healthy to greater effort, or if the arterial 
tensioD i* high we may give nitro-glycerin to lower it and increase 
urinary How. Should pulmonary oedema threaten, atropine may be 
used in full dose with advantage. 

For the support of the heart and respiratory function we employ 
strychnine hypodermically or by the mouth in the dose of ^V to tV 
grain (0.003-0.006), mid follow it by the more powerful stimulanl 
digitalis in the form of the tincture in the dose of 20 minims (1.3). 



VITREOUS DISEASES— VOMITING. 769 

Hypodermic injections of ether are also very valuable if the tissues 
are not too cedematous for absorption to occur. 

The convulsions, if present or threatened, are to be combated by 
the use of an enema of 20 grains of chloral (1.3) and 60 grains (4.0) 
of bromide of sodium in 3 ounces (90.0) of starch-water, and the hot 
pack will also be of value, not only to produce sweating, but for its 
sedative influence on the nervous system. Should the convulsive ten- 
dencies be marked, chloroform inhalations may be employed until the 
chloral or bromide can be absorbed. 

Two other remedial measures should be resorted to in cases of 
uraemia for the relief of all the symptoms — namely, full venesection if 
the pulse is bounding, and hypodermoclysis. (See Part III.) Vene- 
section is contraindicated in the feeble, but as much as 1 to 2 pints (J 
to 1 litre) may be withdrawn in a sthenic case from a vein in the arm. 
After the bloodletting or during its progress hypodermoclysis may 
be performed or a saline solution transfused into a vein. (See Trans- 
fusion.) Often deep insensibility is speedily removed by venesection, 
which should be regarded as the sheet-anchor of treatment in those 
cases which have a high blood-pressure. The author also regards 
hypodermoclysis and intravenous transfusion of salt-solution as most 
useful methods of treatment in this state. 

VITREOUS DISEASES. 

Vitreous opacities may be either dust-like, flaky, or dense and 
membranous. They impair vision in proportion to their number and 
density, and are to be detected with the ophthalmoscope. Patients 
detect them as floating dark spots in their field of vision, because the 
opacities cast a shadow upon the retina. If vitreous disease is 
syphilitic, the usual remedies are indicated. Hypodermic injections 
of pilocarpine act favorably, and in the earlier stages of the inflam- 
mations of the retina, choroid, iris, and ciliary body, upon which the 
opacities depend, leeches should be applied to the temple. Gal- 
vanism has been recommended. 



VOMITING. 

Vomiting is of course a symptom, not a disease, and arises from a 
large number of causes, some of which are very unimportant, others 
very serious. * The most common cause is probably lack of proper 
digestion, with all that this implies ; that is, gastro-intestinal irrita- 
tion and perversion of normal function. Additional causes are cer- 
ebral hemorrhage, tubercular meningitis, cerebritis, uraemia, or dis- 
eases of the middle lobe of the cerebellum, all of which conditions 
cause irritation of the vomiting centre. 1 

All these states may be considered as lesions of a centric charac- 
ter which directly or indirectly cause the vomiting centre to send out 
impulses. On the other hand, it is worthy of note that under certain 
circumstances vomiting may be reflex and dependent upon irritation 

1 See Practical Diagnosis, by the author. Lea Brothers & Co., Philadelphia 
49 



770 DISEASES. 

of the nerves of the stomach or elsewhere which convey impulses to 
the muscles whose activity results in vomiting. These conditions are 
well represented by the vomiting which comes on in incarcerated 
hernia, or in pregnancy, or in that occurring during the passage of 
renal or hepatic calculi, or in indigestion. 

It is important to bear in mind that peripheral vomiting due 
to disorder of the gastric walls may be dependent upon two con- 
ditions. The mucous membrane and its nerves may be over- 
excitable or they may be depressed. For this reason we shall find 
that two modes of treatment are necessary when this subject is 
considered below. 

The mechanism of vomiting consists in the closure of the pyloric 
sphincter, the contraction of the gastric muscles from the pylorus to 
the cardia, and at the same time, and more important than these 
movements, the contraction of the supplementary respiratory and 
abdominal muscles, which so compress the stomach as to drive out its 
contents through the open oesophagus. The violence of the muscular 
contractions in the abdominal walls is greatest when the stomach is 
partly empty, and gives rise to the pain and exhaustion accompanying 
the condition known as retching. The practical point to be learned 
from this is that vomiting is always easier when the stomach is full; 
so if an emetic is given on an empty stomach, as the popular expres- 
sion runs, a large amount of liquid should precede or accompany it if 
possible. Dogs vomit easily because of the development of the gas- 
tric muscles, but they render the effort easier by filling the stomach 
with air, and so completely fill the viscus that its walls can contract 
on a resisting mass. 

Having described the mode and causes of vomiting, it still remains 
for us to consider its treatment. 

It is needless to remark that the vomiting of cerebral disease is 
very intractable, and that very active agents must be used to stop it. 
Probably the vomiting following etherization is centric, and should 
be treated, as should all forms of obstinate emesis, by the injection 
into the rectum of 40 grains (2.65) of sodium or potassium bromide 
and 20 minims of laudanum in 4 to 8 ounces (120.0-240.0) of water. 
If this does not stop the vomiting, a second injection may be given 
one hour after the first. A very valuable remedy in this state is 
acetanilid given in 1 grain (0.05) doses every half hour in a drachm 
of brandy with cracked ice (see Acetanilid), and it is well to remember 
that inhalation of the fumes of vinegar from a cloth wetted with it will 
often be of service. 

When vomiting seems to be due to hyperexcitability of the gastric 
mucous membrane, so that very small amounts of food when swallowed 
arc at once rejected, local anaesthetics and depressants are needed, the 
chief of these being chloretone, cocaine, and aconite. The last two 
drugs, however, have disadvantages, been use in effective dose their 
general physiological action may be very severe and almost poison the 
patient. When given as antiemetics, those drugs act as local anaes- 
thetics, or. in other words, by paralyzing the peripheral sensory nerves 
of the stomach. Cocaine should be given in the dose of 2 to 3 minims 



VOMITING. Ill 

(0.1-0.15) of a 4 per cent, watery solution every fifteen minutes until 
10 minims (0.65) are taken. The aconite should be used in the form 
of the tincture, the patient being placed flat on the back, so as to with- 
stand the ensuing cardiac depression with the least inconvenience, 
and 2 to 5 minims (0.1-0.3) of the tincture given in a little water 
every thirty minutes until the rapidly weakening pulse forbids its 
further use. This drug may be resorted to in all forms of vomiting 
due to irritability of the stomach, but it is contraindicated in cases of 
debility or weakness. Aconite is generally to be preferred to cocaine. 

Two grains of chloretone given in a capsule or dissolved in a little 
brandy, and repeated every hour for 5 doses, are very efficient. 

Sometimes a prescription of the following character is of service, 
the bismuth acting as a coating to the walls of the stomach, protect- 
ing and soothing them : 

R. — Bismuthi subnitrat ^iij (12.0). 

Tr. aconiti rr\, x vel xx (0.65-1.3).— M. 

Ft. chart. No. x. 
S. — One powder every half-hour. 

In other cases of the same type the following is useful, and is to 
be preferred if, owing to active fermentation, the vomiting is excessive 
(the creosote or carbolic acid being a local anaesthetic and antiseptic): 

R. — Acid, carbolic, vel creosoti (beechwood) . gtt. x vel xx (0.65-1.3). 

Bismuthi subnitratis ^iij (12.0).— M. 

Ft. in chart. No. x. 
S. — One powder every hour. 

In other cases 1 drop of tincture of iodine and 1 drop of carbolic acid 
in a couple of drachms of water will act very well. 

Sometimes pure chloroform in 1- or 2-drop (0.05-0.1) doses, in a 
little water, does good ; and dilute hydrocyanic acid, in the dose of 2 
to 6 minims (0.1-0.4) is also of value in like instances, given in a 
tablespoonful (16.0) of water. 

In other instances small repeated doses of nitroglycerin do good 
unless the vomiting complicates peritonitis or pregnancy. Particu- 
larly is nitroglycerin useful in the nausea which often follows the 
use of opium, although this symptom is best prevented by its use. 
The dose used should be about -^ grain (0.0002). 

The treatment of a case of vomiting dependent rather upon de- 
pression and debility of the stomach than upon irritation is directed 
to the administration of gastric and, it may be, systemic stimulants. 
The chief of the gastric stimulants is ipecac in small doses, and it 
it is this employment of a drug generally resorted to for the produc- 
tion of emesis by physicians which has caused homoeopaths to claim 
that the regular school obey the rule of similia similibus curantur and 
infinitesimal doses. The claim only holds good on its face, for we do 
not use an infinitesimal dose, and obey no law, but use common sense. 
Ipecac is an irritant, even to the skin, and it is partly by its irritant 
effects that it causes vomiting by exciting the stomach to a point over 
and above its normal condition. In the vomiting depending upon 
gastric debility and depression small doses of ipecac do good, because 



772 DISEASES. 

they irritate the stomach sufficiently to restore its normal tone with- 
out going to the other extreme of hyperexcitation. Under these cir- 
cumstances a drop dose of the wine of ipecac, or J of a grain (0.016) 
of the powdered ipecac, every hour, is of the greatest value, ofteu 
succeeding after all other remedies have failed. 

In other instances tincture of nux vomica, given in J- to 1-minim 
(0.025-0.05) doses, is useful as follows: 

R. — Tinct. nucis vomicae gtt. iv vel viij (0.25-0.5). 

Aquae cinnamomi fgj (30.0). — M. 

S. — Teaspoonful (4.0j every half-hour or later. 

In the nausea and vomiting following an alcoholic debauch -J- to 1 
minim (0.025-0.05) of Fowler's solution every two hours, or before 
food, often gives relief, and it may be used in some cases in place of 
the nux vomica and ipecac. Another useful measure for the cure of 
alcoholic nausea is the use of full doses of hydrochloric acid, 5, 10, or 
15 minims (0.3-0.65-1.0) of the dilute acid in half a tumblerful of 
water, repeated every two hours. 

In all cases of persistent vomiting counter-irritation should be 
applied over the stomach in the form of a mustard plaster, or, if 
preferred, an ice-bag may be applied to the nape of the neck, the 
lumbar spine, or the epigastrium. Sometimes the application of 
the positive electrode of the rapidly interrupted induced or faradic 
current between the sterno-clavicular muscles while the negative 
electrode is placed on the epigastrium will give relief. In still other 
cases we may freeze the skin over the vagus nerves in the neck by 
the use of a chloride of ethyl spray, or blisters may be applied in its 
stead. 

The food given in cases of vomiting should be especially prepared. 
It is always best to use peptonized milk, made by using the pepton- 
izing materials sold by all the large drug firms of reliability. (See 
article on Diet, Part III.) Lime-water should always be put in the 
milk if it is not peptonized; the small amount usually employed is 
perfectly useless : at least 2 to 3 tablespoonfuls (32.0-48.0) should be 
placed in each glass of milk. 

Another point of importance is the quantity of liquid taken. As 
fast as the patient vomits he is often fed with glasses full of liquid by 
well-meaning friends. Instead of this, he should have only 1 or 2 
teaspoonfuls (4.0-8.0) of milk every hour, half-hour, or fifteen min- 
utes, for it is better for him to retain a drachm, than to take a quart 
and vomit it. Often milk will disagree with the patient, and then we 
can give with excellent result barley gruel, which has been strained, 
and follow it by 3 grains (0.15) of taka diastase. In its place strained 
gruel made from wheaten grits, oatmeal, or rice may also be used. 

Where vomiting is persistent enemata previously partly or entirely 
digested must be resorted to to sustain strength. 

WHOOPING COUGH. 

The remedies recommended for this disease are almost as numer- 
ous as the members of the medical profession, and every one of them 



WORMS. 773 

is worthless so far as a cure is concerned. Probably the very best 
drug of all in the majority of cases is antipyrin. Given in the dose of 
J to 3 grains (0.025-0.15) every five hours according to the age of 
the child, it will nearly always decrease the number of paroxysms, but 
not the severity of each individual attack. 

Where the child will submit to it there is little doubt that a solution 
of quinine applied to the pharynx by means of a very fine spray will 
be of service in many cases, and it is very useful, when so used, as a 
prophylactic in other children of the family who it is feared will be 
attacked by the same disease. The strength of the solution to be 
employed should be about 1 grain (0.05) to the ounce of water. 

There is no doubt that carburetted hydrogen as inhaled in the air at 
gasworks is useful as a curative measure in some cases of whooping cough. 

A very useful remedy in some cases is belladonna in the form of 
the tincture, in the dose of 2 minims (0.01) twice a day to a child of 
one or two years. 

Where paroxysms come on so rapidly as really to interfere seri- 
ously with respiration, the child should take a whiff of chloroform 
poured over the parent's hand, and so relax the spasm, while in other 
instances nitrite of amyl is equally serviceable. Only 2 to 3 minims 
of the nitrite of amyl should be used at a time, and this fact must 
be impressed upon the parents. 

Benzine has been found useful in certain cases of whooping cough. 
It should be lightly sprinkled about the room or on the bed-clothing, 
care being taken that no fire or light is present. In France it has 
been used internally in the dose of 10 to 15 minims (0.6-1.0) for this 
affection. This is scarcely to be recommended. 

Bromoform renders good service in some cases. (See article on 
Bromoform for prescription.) 

The vomiting following the cough may be overcome by using such 
minute amounts of milk as to enable nutrition to go on without at 
any time overloading the stomach, as, for example, a teaspoonful (4.0) 
after each paroxysm of cough. 

Usually it will be found advisable to modify the severity and fre- 
quency of the attacks by keeping the patient under a bronchitis tent or 
by keeping the air of the room moistened by steam. (See Bronchitis.) 

WORMS. 

Intestinal parasites may be said to be represented by the Ascaris 
lumbricoides, or round-worm; the Taenia solium, Taenia media 
canellata, and the Bothriocephalus latus, or tape-worms ; and, finally, 
by the Oxyuris vermicularis, sometimes called seat-, pin-, or thread- 
worm. 

The round-worm and tape-worm are to be attacked by way of the 
patient's mouth, the seat-worm by way of the anal opening ; but 
'before mentioning the drugs to be employed it is necessary to insist 
upon one or two important points, disregard of which will result in 
failure in treatment. 



774 DISEASES. 

Whenever a round- or tape-worm is to be attacked, the patient 
must be starved for at least twelve to twenty-four hours, in order that 
no food in the intestinal tract may protect the worm from the action 
of the drug. During this time a little milk may be taken, and after 
a night of fasting, before breakfast, the anthelmintic must be swal- 
lowed. Further than this, nearly all of these drugs must be followed 
by purges in order to dislodge the intruder while he is paralyzed and 
has lost his hold ; and in many instances it is well to have a basin of 
salt and water ready, so that when a passage occurs a rectal injection 
may be given to wash out any segments of the worm which remain 
behind in the rectum. 

In the treatment of thread-worms it is necessary to fill the bowel 
thoroughly with soap and water to dislodge the faecal matter and 
expose the worms in the folds of the mucous membrane. 

The drugs which are used against the round-worm are: Spigelia in 
the form of the fluid extract, dose 1 drachm (4.0) to a child of two 
or three years, or 2 drachms (8.0) to an adult, or, better still, the fluid 
extract of spigelia and senna, dose 2 to 3 drachms (8.0-12.0), given 
in divided doses, to a child ; oil of chenopodium, dose 5 to 20 drops 
(0.3-1.3) on sugar; santonin, dose J to J grain (0.016-0.025) to a 
child, in the form of troche, made by using the crystals, or as much 
as 2 to 4 grains (0.1-0.2) to an adult. (See Santonin.) 

Bravera, or kooso, is given for the removal of the tape-worm in 
the form of an infusion, which is made by adding J ounce (16.0) of 
the powdered leaves to 1 pint (500 cc.) of water and mucilage of 
acacia, one-half of each. This may be taken at one dose, or the 
fluid extract may be given in the dose of \ ounce (16.0) to an adult. 
Koosin may be given in 40-grain (2.65) doses in capsule to adults, 
but it should not be used against worms in pregnant women, as it 
may cause abortion. 

Unless the spigelia is used with senna, it should always be followed 
after from two to four hours by a full dose of castor oil or a saline 
purgative to sweep out the worm, and the same rule applies to all the 
drugs mentioned above. 

The most efficient remedy against the tape-worm is pelletierin, 
the active principle of pomegranate, dose 3 to 5 grains (0.18-0.26) in 
capsules; or pepo, or pumpkin-seeds (2 ounces [64.0]), may be 
resorted to when deprived of their outer coating and rubbed into a 
paste with sugar. Almost, if not quite, as valuable a remedy is male 
fern, or Filix mas, or, as it is officially called, Aspidium. Used in 
the form of the oleoresin {Oleoresina Aspidii), in the dose of I to 1 
drachm (2.0-4.0) to an adult, it should be followed in three or four 
hours by a calomel purge, aided by a saline. Either the calomel or 
the increased amount of bile which is present is apparently peculiarly 
abhorrent to the tape-worm, and its free excretion should follow the 
use of all the drugs just named. Aspidium should not be followed 
by castor or other oils, as they increase the absorbability of the drug, 
and so tend to develop poisonous symptoms. 

By far the most useful remedy for seat-worms is quassia used by 
injection. 1 to 2 ounces (30.0-60.0) of powdered quassia or quassia 



WORMS. 775 

chips may be made into a decoction with a pint (500 cc.) of water, 
and half of this injected into the rectum after it has been well 
cleansed with soap and water. The quassia injection should be 
retained in the bowel for some minutes, and in children this may be 
accomplished by pressing upon the anal opening the ball of the 
thumb covered by a pad formed from a small folded towel. If this 
treatment fails to bring away all the worms in three or four trials, 
either there are none present or the bowel is not thoroughly invaded 
by the injection. In some cases the worms infest the colon, and large 
injections sent high up into the bowel are necessary. 



DOSES OF MEDICINES. 



The doses in this table are commonly employed. They are not always equivalent 
to those given in the text, which are used by the author as a rule. 

dr. = drachm ; fl. dr. = fluidrachm ; fl. oz. = fluidounce ; gr. = grain ; c/m. = gramme ; 
cc. cubic centimetre ; rain. = minim : oz. = ounce. 



Remedy. 



Acetanilid 

Acetophenone 

Acetphenetidin 

Acetum lobelia 

opii 

sanguinariae 

scillse . 

Acid, acetic, diluted . . . 

arsenous 

solution of (Ph. U. S.) 

benzoic 

boric 

carbolic 

chrysophanic 

citric 

fluoric, dilute 

gallic 

hydriodic, dilute . . . 

hydrobromic, dilute . . 

hydrochloric 

dilute 

hydrocyanic, dilute . . 

lactic 

nitric 

dilute 

nitrohydrochloric . . . 

phosphoric, dilute . . . 

picric 

polygalic 

salicylic 

sulphuric 

aromatic 

dilute 

sulphurous 

tannic ...:.... 

tartaric 

valerianic 

Aconite, abstract of . . . 

leaves, extract of . . . 
fluid extract of . . . 
tincture of 

root, extract of ... . 
fluid extract of . . . 

tincture of 

Aconitine 

Adonidin 

^Ether. See Ether. 



Dose. 



Apothecaries' 
Weights and Measures. 



1-8 gr. 

5-20 min. 

2-5 gr. 
15-30 min. 

5-10 min. 
15-30 min. 
10-30 min. 

1-2 fl. dr. 

eWff g r - 

2-8 min. 

5-15 gr. 

5-10 gr. 

i-lgr. 

|~5 min. 

5-20 gr. 
10-20 min. 

3-15 gr. 

*fl. dr. 

i-2fl.dr. 

2-5 min. 
10-20 min. 

2-5 min. 

1-3 dr. 

2-5 min. 
10-25 min. 

2-5 min. 

5-25 min. 

1-5 gr. 

^Igr. 
5-15 gr. 
2-5 min. 
5-20 min. 
5-20 min. 
1-1 fl. dr. 
2-10 gr. 
10-30 gr. 
3-4 min. 

i-i & : 

1-5 min. 
10-15 min. 

£-£gr : 

|— 1 min. 
1-3 min. 

lio" "jfc g r - 



Metric 
System. 



0.06-0.5 gm. 

0.3-1.25 gm. 
0.12-0.3 gm. 

1.0-2.0 cc. 

0.3-0.6 cc. 

1.0-2.0 cc. 

0.6-1.8 cc. 

4.0-8.0 cc. 
0.001-0.003 gm. 
0.12-0.5 cc. 

0.3-1.0 gm. 

0.3-0.6 gm. 
0.03-0.06 gm. 
0.008-0.3 gm. 

0.3-1.25 gm. 

0.6-1.2 cc. 

0.2-1.0 gm. 
2.0 cc. 

2.0-8.0 cc. 
0.12-0.3 cc. 

0.6-1.2 cc. 
0.12-0.3 cc. 

4.0-12.0 gm. 
0.12-0 .3 cc. 

0.6-1.5 cc. 
0.12-0.3 cc. 

0.3-1.5 cc. 
0.06-0.3 gm. 
0.015-0.06 gm. ' 

0.3-1.0 gm. 
0.12-0.3 cc. 

0.3-1.2 cc. 

0.3-1.2 cc. 

2.0-4.0 cc. 
0.12-0.6 gm. 

0.6-2.0 gm. 

0.2-0.25 cc. 
0.015-0.03 gm. 
0.015-0.03 gm. 
0.06-0.3 cc. 

0.6-1.0 cc. 

0.01-0.016 gm. 

0.03-0.06 cc. 

0.06-0.18 cc. 

0.00015-0.0002 gm. 

0.005-0.01 em. 



777 



778 



DOSES OF MEDICINES. 



Remedy. 



Agaricin 

Aloes 

extract of 

and myrrh, tincture of 

tincture of 

watery extract 

wine of 

Aloin 

Alumen 

(as emetic) 

Aluminium hydrate 

Ammonia, aromatic spirit 

solution of acetate of 

spirit of 

water of 

Ammoniacum 

mixture 

Ammonium benzoate 

bromide 

carbonate 

chloride 

iodide 

phosphate 

picrate 

sulphate 

valerianate 

Amygdala amara, water of 

Amyl nitrite 

by inhalation 

Amylene hydrate 

Amylum iodatum 

Angelica-root, fluid extract . ■ 

Angustura-bark 

Anise, oil of 

spirit of 

Anthemis 

extract 

fluid extract 

Antimonial powder 

Antimony oxide 

oxysulphuret 

and potassium tartrate, as diaphoretic 
as emetic 

sulphide 

sulphurated 

sulphuret 

wine of 

Antipyrine 

A ntitoxine (for diphtheria) 

Apiol 

Apocynin 

Apoeynum cannabinum 

fluid extract of 

Apomorphine hydrochlorate 

Aralia hispida, fluid extract of .... 

nudicaulis, fluid extract of 

racemosa, fluid extract of 

spinosa, fluid extract of 

Arbutin 

Areca, fluid extract of 

Argentum and compounds. See Silver. 
Arnica-flowers, extract of 



Dose. 



Apothecaries' 
Weights and Measures. 



tW gr. 
2-6 gr. 
2-6 gr. 
1-2 fl. dr. 
1-2 fl. dr. 
1-2 gr. 
1-2 fl. dr. 

5-10 gr. 
30 gr.-l dr. 

5-15 gr. 
30 min.-l fl. dr. 

1-2 fl. dr. 

5-15 min. 

5-15 min. 
10-30 gr. 

£-1 oz. 
10-20 gr. 
10-30 gr. 

3-10 gr. 

5-10 gr. 

3-5 gr. 
10-20 gr. 

?-lg r - 

3-10 gr. 

2-8 gr. 

1-2 fl. dr. 

2-3 min. 

3-5 min. 
10-30 min. 

5-30 gr. 
30-60 min. 
10-30 gr. 

1-5 min. 

1-2 fl. dr. 

i-1 dr. 

2-10 gr. 
30-60 min. 

1-3 gr. 

2-3 gr. 
-2gr. 

-Igr. 
-1 gr. 
1-2 gr. 
1-2 gr. 
f-2 gr. 
10 min.-l fl. dr. 
5-15 gr. 
5-10 cc. 
2-5 gr. 
*-2gr. 
10-20 gr. 
10-30 min. 

tWV g r - 
30-60 min. 
30-60 min. 
30-60 min. 
30-60 min. 

1-10 gr. 
30-60 min. 

2-5 irr. 



i_ 

•r 

tV 
i 

T 



Metric 
System. 



0.005-0.015 gm. 

0.1-0.35 gm. 

0.1-0.35 gm. 

4.0-8.0 cc. 

4.0-8.0 cc. 
0.03-0.12 gm. 

4.0-8.0 cc. 
0.016-0.03 gm. 

0.3-0.6 gm. 

2.0-4.0 gm. 

0.3-1.0 gm. 

2.0-4.0 cc. 

4.0-8.0 cc. 

0.6-1.0 cc. 

0.6-1.0 cc. 

0.6-2.0 gm. 
16.0-32.0 cc. 

0.6-1.2 gm. 

0.6-2.0 gm. 
0.18-0.6 gm. 

0.3-0.6 gm. 
0.18-0.3 gm. 

0.6-1.2 gm. 

0.016-0.03 gm. 

0.18-0.6 gm. 

0.12-0.48 gm. 

4.0-8.0 gm. 
0.12-0.18 cc. 
0.18-0.3 cc. 

0.6-2.0 gm. 

0.3-2.0 gm. 

2.0-4.0 gm. 

0.6-2.0 gm. 
0.06-0.3 cc. 

4.0-8.0 cc. 

2.0-4.0 cc. 
0.12-0.6 gm. 

2.0-4.0 cc. 
0.06-0.18 gm. 
0.12-0.18 gm. 
0.03-0.12 gm. 
0.004-0.03 gm. 
0.03-0.06 gm. 
0.03-0.12 gm. 
0.06-0.12 gm. 
0.03-0.12 gm. 

0.6-4.0 cc. 

0.3-1.0 gm. 

0.12-0.3 gm. 
0.03-0.12 gm. 

0.6-1.2 gm. 

0.6-2.0 cc. 
0.004-0.006 gm, 

2.0-4.0 cc. 

2.0-4.0 cc. 

2.0-4.0 cc. 

2.0-4.0 cc. 
0.06-0.6 gm. 

2.0-4.0 cc. 

0.12-0.3 gm. 






DOSES OF MEDICINES. 



779 



Remedy. 



Arnica-flowers, fluid extract of 

root, extract of ... - 

fluid extract of 

tincture of 

Aromatic powder 

Arsenate of sodium, solution of 

Arsenic. See Acid, arsenous. 

bromide 

iodide 

and mercury iodide, solution of (Dono- 
van's solution) 

Arsenite of potassium, solution of (Fowler's 

solution) 

Asafoetida 

mixture of 

tincture 

Asclepias incarnata, fluid extract of ... 

Syriaca, fluid extract of 

tuberosa 

Aspidium, fluid extract of 

oleo-resin of 

Aspidosperma, abstract of 

fluid extract of 

Atropine sulphate . 

Aurantii cortex, fluid extract of 

Azedarach, fluid extract of 

Balsam of Gurjun 

of Tolu 

Baptisia, extract of 

fluid extract of 

Baptisine 

Belladonna, abstract of 

alcoholic extract of 

leaves, fluid extract of 

tincture of 

root, extract of 

fluid extract of 

Benzanilide 

Benzoin, compound tincture of 

tincture of 

Benzol 

Berberina 

sulphate 

Berberis aquifolium, fluid extract of . . . 

vulgaris, fluid extract of 

Bismuth and ammonium, citrate of ... . 

citrate 

salicylate 

subcarbonate 

subnitrate 

tannate 

valerianate ! . 

Boldo, fluid extract of 

oil of 

tincture of 

Brayera 

fluid extract of 

infusion of 

Bromal 

Bromoform . 

Brucina ...... 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


5-15 min. 


0.3-1.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


5-1 5 min. 


0.3-1.0 cc. 


10-20 min. 


0.6-1.2 cc. 


10-30 gr. 


0.6-2.0 gm. 


3-5 min. 


0.18-0.3 cc. 


eWo g r - 


0.001-0.004 gm. 


I 1 „r 


0.004-0.008 gm. 


2-4 min. 


0.1-0.2 cc. 


2-5 min. 


0.12-0.3 cc. 


5-20 gr. 


0.3-1.2 gm. 


£-1 fl. oz. 


15.0-30.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


5-20 gr. 


0.3-1.2 gm. 


15-30 min. 


1.0-2.0 cc. 


-As ¥0 g r - 


0.0005-0.0015 gm. 


15 min.-2 fl. dr. 


1.0-8.0 cc. 


15-60 min. 


1.0-4.0 cc. 


20-30 min. 


1.2-2.0 cc. 


10-30 min. 


0.6-2.0 cc. 


2-10 gr. 


0.12-0.6 gm. 


10-30 min. 


0.6-2.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


i-li gr- 


0.03-0.1 gm. 


Hgr. 


0.016-0.03 gm. 


3-6 min. 


0.18-0.36 cc. 


10-20 min. 


0.6-1.2 cc. 


f-igr. 


0.008-0.016 gm. 


1-2 min. 


0.06-0.12 cc. 


1-5 gr. 


0.06-0.3 gm. 


J-l fl. dr. 


2.0-4.0 cc. 


i-1 fl. dr. 


2.0-4.0 cc. 


5-10 min. 


0.3-0.6 cc. 


3-10 gr. 


0.18-0.6 gm. 


3-10 gr. 


0.18-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-10 gr. 


0.06-0.6 gm. 


3-15 gr. 


0.18-1.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


5-20 gr. 


0.3-1.2 gm. 


5-20 gr. 


0.3-1.2 gm. 


5-30 gr. 


0.3-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


8 min. 


0.5 cc. 


2-3 dr. 


8.0-12.0 gm. 


i-1 fl. oz. 


15.0-30.0 cc. 


4-8 oz. 


118.0-236.0 cc. 


2-3 gr. 


0.12-0.2 gm. 


5-10 min. 


0.3-0.6 cc. 


aWe gr- 


0.002-0.004 gm. 



'80 



DOSES OF MEDICINES. 



Remedy. 



Bryonia, fluid extract of 

tincture of 

Buchu, fluid extract of 

Buckthorn, fluid extract of 

Cactus grandiflora, fluid extract of . . 
Caffeine 

citrate of 

Cajuput, oil of .... 

Calamus, fluid extract of 

Calcium benzoate 

bromide 

carbonate 

chloride 

hypophosphite 

iodide 

lactophosphate, syrup of 

phosphate 

sulphide 

Calendula, fluid extract of 

tincture of 

Calomel. See Mercury, mild chloride of. 
Calumba, extract of 

fluid extract of 

tincture of 

Calx chlorata 

sulphurata 

Camphor 

bromide 

monobromated 

spirit of. 

water 

Camphoric acid 

Cannabin tannate 

Cannabis Americana, fluid extract of . 

Indica, abstract of 

extract of 

fluid extract of 

tincture of 

Cantharides 

tincture of 

Capsicum 

fluid extract of 

oleoresin of 

tincture of 

Caraway, oil of 

Carbon bisulphide 

Cardamom, compound tincture of . . 

fluid extract of 

tincture of 

Carvophyllus, oil of 

Cascara sagrada 

extract of 

fluid extract of 

Casearilla 

fluid extract of 

Cassia fistula, pulp of 

Castanea vesca, fluid extract of . . . . 
Castor 

tincture of 

Cataria, fluid extract of 

Catechu 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


15-60 min. 


1.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


f-1 fl. dr. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-10 min. 


0.3-0.6 cc. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-20 min. 


0.3-1.2 cc. 


15-60 min. 


1.0-4.0 cc. 


10 gr. 


0.6 gm. 


10-20 gr. 


0.6-1.2 gm. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


15-30 gr. 


1.0-2.0 gm. 


Hgr- 


0.012-0.03 gm. 


15-60 min. 


1 .0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


3-10 gr. 


0.18-0.6 gm. 


15-60 min. 


1.0-4.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


i-lgr. 


0.016-0.006 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-30 min. 


0.3-2.0 cc. 


|-2 fl. oz. 


16.0-64.0 cc. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


3-15 min. 


0.18-1.0 cc. 


1-3 gr. 


0.06-0.18 gm. 


Hgr. 


0.015-0.06 gm. 


3-6 min. 


0.18-0.36 cc. 


30-60 min. 


2.0-4.0 cc. 


*-l ^. 


0.03-0.06 gm. 


2-10 min. 


0.12-0.6 cc. 


1-2 gr. 


0.03-0.12 gm. 


^-1 min. 


0.03-0.06 cc. 


£-1 min. 


0.015-0.06 cc. 


5-20 min. 


0.3-1.2 cc. 


1-5 min. 


0.06-0.3 cc. 


^-1 min. 


0.03-0.06 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


15-45 min. 


1.0-3.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-5 min. 


0.06-0.3 cc 


2-8 gr. 


0.12-0.5 gm. 


2-8 gr. 


0.12-0.5 gm. ' 


10-30 min. 


0.6-2.0 cc. 


20-30 gr. 


1.2-2.0 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-2 dr. 


4.0-8.0 gm. 


£-1 fl. dr. 


2.0-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


2-4 fl. dr. 


8.0-16.0 cc. 


15 min.-l fl. dr. 


1.0-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 



DOSES OF MEDICINES. 



781 



Kemedy. 



Catechu, compound tincture of ... . 

fluid extract of 

Caulophyllin 

Caulophyllum, infusion of 

Cava-cava 

Cerium nitrate 

oxalate 

Chalk, compound powder of 

mixture 

prepared 

Chamomile, oil of 

Charcoal, animal, purified 

Chelidonium majus 

extract of 

fluid extract of 

Chenopodium, oil of 

Cherry-laurel water 

Chimaphila, fluid extract of 

Chinoidin 

Chionanthus, fluid extract of ... . 
Chiretta, fluid extract of 

tincture of 

Chloral hydrate 

Chloralamide 

Chlorine-water 

Chloroform, mixture of 

purified 

spirit of 

Chrysarobin 

Cimicifuga, fluid extract of 

tincture of 

Cinchona-bark 

aromatic fluid extract of 

compound tincture of 

extract of 

fluid extract of 

tincture of 

Cinchonia sulphate 

Cinch onidia or Cinchonidine sulphate 

Cinchonine sulphate 

Cinnamon 

oil of 

spirit of 

tincture of 

Cloves. See Caryophyllus. 

Coca, fluid extract of 

leaves of 

Cocaine 

Cocculus, fluid extract of 

tincture of 

Codeine or Codeia 

Colchicine 

Colchicum, acetic extract of 

root 

extract of 

fluid extract of 

wine of 

seed 

fluid extract of 

tincture of 

wine of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


Hgr- 


0.015-0.03 gm. 


1-2 oz. 


16.0-64.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


l-2gr. 


0.06-0.12 gm. 


1-2 gr. ■ 


0.06-0.12 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-2 fl. oz. 


32.0-64.0 gm. 


15-30 gr. 


1.0-2.0 gm. 


5-15 min. 


0.3-1.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-1 dr. 


2.0-4.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


4-8 min. 


0.24-0.5 cc. 


5-30 min. 


0.3-2.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


30-60 min. 


2.0-4.0 cc. 


\rl fl. dr. 


2.0-4.0 cc. 


15-60 min. 


1.0-4.0 cc. 


5-20 gr. 


0.3-1.2 gm. 


15-30 gr. 


1.0-2.0 gm. 


1-4 fl. dr. 


4.0-15.0 cc. 


1-4 fl. dr. 


4.0-15.0 cc. 


5-10 min. 


0.3-0.6 cc. 


10 min.-l fl. dr. 


0.6-4.0 cc. 


5-20 gr. 


0.3-1.2 gm. 


10-30 min. 


0.6-2.0 cc. 


i-1 fl. dr. 


2.0-4.0 cc. 


10 gr.-l dr. 


0.6-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1-2 fl. dr. 


8.0-15.0 cc. 


10-20 gr. 


0.6-1.2 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-20 gr. 


0.3-1.2 gm. 


1-5 min. 


0.06-0.3 cc. 


5-20 min. 


0.3-1.2 cc. 


f-2 fl. dr. 


2.0-8.0 cc. 


20 min.-l fl. dr. 


1.2-4.0 cc. 


i-1 dr. 


2.0-4.0 gm. 


i-1 g^ 


0.03-0.06 gm. 


1-3 min. 


0.06-0.2 cc. 


2-10 min. 


0.12-0.6 cc. 


1-2 gr. 


0.06-0.12 gm. 


iro o-to gr- 


0.0012-0.0006 gm. 


i-i gr- 


0.015-0.03 gm. 


2-5 gr. 


0.12-0.3 gm. 


Hgr- 


0.015-0.03 gm. 


2-5 min. 


0.12-0.3 cc. 


10-20 min. 


0.6-1.2 cc. 


2-10 gr. 


0.12-0.6 gm. 


2-8 min. 


0.12-0.5 cc. 


10-90 min. 


0.6-3.0 cc. 


20-40 min. 


1.2-2.4 cc. 



/8Z 



DOSES OF MEDICINES. 



Remedy. 



Colocynth 

compound extract of 

extract of 

Colocynthidine 

Colocynthin 

Condurango, fluid extract of ... . 
Coniine 

hydroehlorate 

Conium, abstract of . . ■ 

fluid extract of 

fruit, alcoholic extract of ... , 

fluid extract of 

tincture of ....... . 

leaves, extract of ■ . , 

fluid extract of , 

Convallamarin 

Convallaria, extract of 

fluid extract of 

Copaiba 

oil of 

Copper, acetate 

ammoniated 

sulphate, astringent, tonic . . . 

emetic 

Coptis, fluid extract of 

Corrosive sublimate. See Mercury. 
Corydalis, fluid extract of ... . 
Goto 

fluid extract of 

tincture of 

Cotoi'n 

Cotton-root bark. See Gossypium. 
Creasote 

water 

Creolin 

Croton-chloral hydrate 

Croton oil 

Cubebs 

fluid extract of 

oil of 

oleoresin of 

tincture of 

Curare 

Curarin 

Cypripedium 

fluid extract of 

Damiana, fluid extract of ... . 

tincture 

Daturine 

I delphinium, fluid extract of . . . 

Digitaline 

Digitalis, abstract of 

extract of 

fluid extract of 

infusion of 

powder of leaves of 

tincture of 

Dioscorea, fluid extract of ... . 

Dita, fluid extract of 

Dogwood, bark of root 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-8 gr. 


0.12-0.5 gm. 


5-10 gr. 


0.3-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


tW gr- 


0.005-0.01 gm. 


¥-i gr. 


0.015-0.06 gm. 
0.6-2.0 cc. 


10-30 min. 


■h-i? g r - 


0.001-0.002 gm. 


■hrh g r - 


0.001-0.002 gm. 


1-2 gr. 


0.6-0.12 gm. 


5 min. 


0.3 cc. 


4-1 gr- 


0.03-0.06 gm. 


1-2 min. 


0.06-0.12 cc. 


10-20 min. 


0.6-1.2 cc. 


1-2 gr. 


0.06-0.12 gm. 


1-3 min. 


0.06-0.18 cc. 


f-2gr. 


0.03-0.12 gm. 


2-10 min. 


0.12-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


20 min. -1 fl. dr. 


1.2-4.0 cc. 


10-20 min. 


0.6-1.2 cc. 


Hgr. 


0.015-0.03 gm. 


i-1 gr- 


0.01-0.06 gm. 


Hgr- 


0.015-0.03 gm. 


5gr. 


0.3 gm. 


30-60 min. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-2 gr. 


0.06-0.12 gm. 


5-15 min. 


0.3-1.0 cc. 


2-10 min. 


0.12-0.6 cc. 


TV! gr- 


0.005-0.008 gm. 


1-3 min. 


0.06-0.18 cc. 


1-4 fl. dr. 


4.0-15.0 cc. 


igr- 


0.03 gm. 


2-10 gr. 


0.12-0.6 gm. 


\-l min. 


0.03-0.06 cc. 


10 gr.-l dr. 


0.6-4.0 gm. 


15-30 min. 


1.0-2.0 cc. 


10-20 min. 


0.6-1.2 cc. 


5-20 min. 


0.3-1.2 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1 I or 
3^8 g r - 


0.002-0.008 gm. 


*Ws gr- 


0.001-0.002 gm. 


15 gr. 


1 gm. 


15-30 min. 


1.0-2.0 cc. 


30 min.-2 fl. dr. 


2.0-8.0 cc. 


1-3 fl. dr. 


4.0-12.0 cc. 


TtfWo g r - 


0.0006-0.0012 gm. 


1-3 min. 


0.06-0.2 oc. 


*W<r gr- 


0.001-0.002 gm. 


1-2 gr. 


0.06-0.12 gm. 


Mgr- 


0.01-0.03 gm. 


1-6 min. 


0.06-0.35 cc. 


2-4 fl. dr. 


8.0-16.0 cc. 


¥-!&• 


0.03-0.06 gm. 


5-20 min. 


0.3-1.3 cc. 


15-30 min. 


1.0-2.0 cc. 


1-4 min. 


0.06-0.25 cc. 


20-60 gr. 


1.2-4.0 gm. 



DOSES OF MEDICINES. 



r 83 






Remedy. 



Dogwood, fluid extract of 

Donovan's solution. See Arsenic. 

Dover's powder 

Dracontium 

fluid extract of 

Drosera, fluid extract of 

Duboisine 

Dulcamara, extract of 

fluid extract of ... , 

Elaterin . _> 

Elaterium 

Emetin, diaphoretic 

emetic 

Ergot 

extract of , . . . . . . . . 

fluid extract of . . . 

tincture of . . . 

wine of 

Ergotin, Bonjean's (purified extract of ergot) 

Erigeron, oil of 

Eriodictyon, extract of 

fluid extract of 

Erythrophlcein . . . . . 

Erythroxylon. See Coca. 

Eserine 

Ether, acetic 

compound spirit of (Hoffman's anodyne) 

nitrous, spirit of (sweet spirit of nitre) . 

sulphuric 

Ethyl bromide 

Eucalyptol 

Eucalyptus, fluid extract of 

oil of 

Euonymin 

Euonymus, extract of 

fluid extract of 

Ewpatorium, fluid extract of 

Euphorbia pilulifera, fluid extract of . . . 

Fel bovis purificatum 

Ferrum. See Iron. 

Frangula, fluid extract of 

Galls, aromatic syrup of 

fluid extract of 

tincture of . 

Gamboge 



Gelsemium, abstract of ... . 

extract of 

fluid extract of 

tincture of 

Gentian, compound infusion of . 

extract of 

fluid extract of 

tincture of 

Geranium, fluid extract of . . . 
Ginger, fluid extract of ... . 

oleo-resin of . 

tincture of 

Glycyrrhiza. See Licorice. 

Goa powder 

Gold bromide 



Dose. 



Apothecaries' 
Weights and Measures. 



30-60 min. 

5-10 gr. 
10-20 gr. 
i-l fl. dr. 
5-10 min. 

5-10 gr. 

i-l fl. dr. 
*Wo g r - 
iWgr. 
xh-io g r - 

1-i gr- 
15-60 gr. 

2-10 gr. 
15 min.-l fl. dr. 

4-2 fl. dr. 

1-3 fl. dr. 

2-8gr._ 

5-15 min. 

2-5 gr. 
15-30 min. 



eWo gr- 
10-20 min. 
30 min. 

i-l fl. dr. 
15-40 min. 
15-60 min. 
10-15 min. 
15-30 min. 

5-10 min. 

2-5 gr. 

1-3 gr. 

f-1 fl. dr. 

i-l fl. dr. 

5-30 min. 

3-6 gr. 

15-30 min. 
1-2 fl. dr. 
1-2 fl. dr. 
i-2 fl. dr. 
f-4 gr. • 
2-10 min. 
1-2 gr. 

i-l gr- 

2-5 min. 

5-10 min. 

1-4 fl. dr. 

2-3 gr. 

i-l fl. dr. 

1-2 fl. dr. 
20-30 min. 
10-30 min. 

1-3 gr. 
15-30 min. 

5-20 gr. 



Metric 

System. 



2.0-4.0 cc. 

0.3-0.6 gm. 
0.6-1.2 gm. 
2.0-4.0 cc. 
0.3-0.6 cc. 

0.0006 gm. 

0.3-0.6 gm. 

2.0-4.0 cc. 

0.001-0.003 gm. 

0.006-0.015 gm. 

0.0005-0.002 gm. 

0.008-0.015 gm. 

1.0-4.0 gm. 

0.12-0.06 gm. 

1.0-4.0 cc. 

2.0-8.0 cc. 

4.0-12.0 cc. 

0.12-0.5 gm. 

0.3-1.0 gm. 

0.12-0.3 gm. 

1.0-2.0 cc. 

0.004-0.008 gm. 



0.001-0 

0.6-1 

2. 

2.0-4 

1.0-2 

1.0-4 

0.6-1 

1.0-2 

0.3-0 

0.12-0 

0.06-0 

2.0-4 

2.0-4 

0.3-2 

0.18-0, 



.003 gm. 

.2cc. 

.Occ. 

.Occ. 

.5 cc. 

.Occ. 

.Occ. 

.0 cc. 

.6 cc. 

.3gm. 

.18 gm. 

.Occ. 

.Occ. 

.Occ. 

>.36 gm. 



1.0-2.0 cc. 

4.0-8.0 cc. 

4.0-8.0 cc. 

2.0-8.0 cc. 
0.03-0.25 gm. 
0.12-0.6 cc. 
0.06-0.12 gm. 
0.03-0.06 gm. 
0.12-0.3 cc. 

0.3-0.6 cc. 

4.0-8.0 cc. 
0.12-0.2 gm. 

2.0-4.0 cc. 

4.0-8.0 cc. 

1.2-2.0 cc. 

0.6-2.0 cc. 
0.06-0.18 gm. 

1.0-2.0 cc. 

0.3-1.2 gm. 

0.008-0.03 gm. 



'84 



DOSES OF MEDICINES. 



Remedy. 



Gold and sodium chloride 

Gossypium-root, fluid extract of bark of 
Granati radicis cortex, fluid extract . . 

Grindelia, fluid extract of 

Guaiac, animoniated tincture of . . . 

resin of 

tincture of 

Guaiacol 

Guarana 

fluid extract of 

Gurjun. See Balsam. 

Haematoxylon 

extract of 

fluid extract of 

Hamamelis, fluid extract of 

Hedeoma, oil of 

Helleborein 

Helleborus niger, extract of 

fluid extract of 

tincture of 

Hepatica, fluid extract of 

Hops, extract of 

fluid extract of 

tincture of 

Hydrangea, fluid extract of 

Hydrastine 

Hydrastis, extract of 

fluid extract of 

tincture of 

Hyoscine hydrobromate 

Hyoscyamine sulphate 

Hyoscyamus, abstract of 

alcoholic extract of 

extract of 

fluid extract of flowers 

of seeds 

tincture of flowers 

of seeds 

Hypnal 

Hypnone 

Hypophosphites, syrup of 

with iron, syrup of 

Ichthyol 

Ignatia, abstract of 

extract of 

fluid extract of 

tincture of 

Iodine, compound solution of ... . 

tincture of 

Iodoform ... 

Iodol 

Ipecacuanha, emetic 

expectorant 

abstract of 

fluid extract of, emetic 

syrup of 

wine of, emetic 

expectorant . . 

Iridin or Irisin 

Iris, extract of 

fluid extract of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


?Wo g r - 


0.001-0.003 gm. 


i-1 fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


£-1 fl. dr. 


2.0-4.0 cc. 


30-60 min. 


2.0-4.0 cc. 


10-20 gr. 


0.6-1.2 gm. 


30-60 min. 


2.0-4.0 cc. 


i-3 gr. 


0.03-0.18 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


10-20 gr. 


0.6-1.2 gm. 


10-20 gr. 


0.6-1.2 gm. 


30-60 min. 


2.0-4.0 cc. 


30 min.-2 fl. dr. 


2.0-8.0 cc. 


2-5 min. 


0.12-0.3 cc. 


tV? gr- 


0.006-0.016 gm. 


i"2gr. 


0.03-0.12 gm. 


5-15 min. 


0.3-1.0 cc. 


10-15 min. 


0.6-1.0 cc. 


30-60 min. 


2.0-4.0 cc. 


3-15 gr. 


0.2-1.0 gm. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


i-lgr. 


0.015-0.03 gm. 


3-10 gr. 


0.2-0.6 gm. 


10-30 min. 


0.6-2.0 cc. 


30-60 min. 


2.0-4.0 cc. 


To-Wo g r - 


0.0006-0.001 gm. 


Thmk g r - 


0.0005-0.001 gm. 


2-3 gr. 


0.12-0.2 gm. 


1-2 gr. 


0.06-0.12 gm. 


2-3 gr. 


0.12-0.2 gm. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


1-5 gr. 


0.06-0.3 gm. 


1 fl. dr. 


4.0 cc. 


1 fl. dr. 


4.0 cc. 


2-4 gr. 


0.1-0.25 gm. 


1-3 gr. 


0.06-0.2 gm. 


i-lgr. 


0.015-0.06 gm. 


1-6 min. 


0.06-0.35 cc. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


2-4 min. 


0.1-0.2. cc. 


1-3 gr. 


0.06-0.2 gm. 


-H*gr. 


0.03-0.12 gm. 


15-30 gr. 


1.0-2.0 gm. 


i-1 gr. 


0.01-0.06 gm. 


5-30 gr. 


0.3-2.0 gm. 


15-30 min. 


1.0-2.0 cc. 


£-1 fl. dr. 


2.0-4.0 cc. 


3-6 fl. dr. 


12.0-24.0 cc. 


5-15 min. 


0.3-1.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


1-3 gr. 


0.06-0. IS gm. 


5-15 min. 


0.3-1.0 cc. 



DOSES OF MEDICINES. 



785 




Iron acetate, tincture of . . 

and ammonium citrate 

sulphate 

tartrate 

arsenate 

benzoate 

bitter wine of 

bromide 

syrup of 

carbonate, saccharated 

chloride 

tincture of .... . 

and cinchonidia citrate . 

citrate 

compound mixture of . 

dialyzed 

solution of 

hyd rated oxide of . . . 

hypophosphite 

syrup of 

iodide 

syrup of 

lactate 

magnetic oxide of . . . 

malate 

nitrate, solution . , . . 

phosphate 

pomate 

and potassium tartrate . 

pyrophosphate 

and quinia citrate . . . 

reduced 

saccharated carbonate of 

and strychnine citrate . 

subcarbonate ...... 

subsulphate 

sulphate ....... 

dried 

valerianate 

wine of the citrate of . . 
Jaborandi, extract of . . . 

fluid extract of . . . . 
Jalap 

abstract of 

compound powder of . . 

extract of 

alcoholic extract of . . 

fluid extract of . . . . , 

resin of 

tincture of 

Juglans, extract of ... . 

fluid extract of . . . . 
Juniperus, fluid extract of 

Kairin 

Kamala 

fluid extract of . . . . 
Kino ... 

fluid extract of . . . . 

tincture of 

Kola, fluid extract of . . . 
Koosso. See Brayera 
50 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


15-30 min. 


1.0-2.0 cc. 


5-10 gr. 


0.3-0.6 gm. 


5-10 gr. 


0.3-0.6 gm. 


5-15 gr. 


0.3-1.0 gm. 


1 _ 1 or 

¥o ^o & r - 


0.0015-0.003 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


15-60 min. 


1.0-4.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


10-30 min. 


0.6-2.0 cc. 


5-10 gr. 


0.3-0.6 gm. 


5-10 gr. 


0.3-0.6 gm. 


1-2 fl. oz. 


30.0-60.0 cc. 


5-15 min. 


0.3-1.0 cc. 


10-30 min. 


0.6-2.0 cc. 


Tablespoonful doses i 


n arsenical poisoning. 


5-10 gr. 


0.3-0.6 gm. 


1 fl. dr. 


4.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


10-30 min. 


0.6-2.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


5-10 gr. 


0.3-0.6 gm. 


5-15 gr. 


0.3-1.0 gm. 


8-15 min. 


0.5-1.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


5-15 gr. 


0.3-1.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-10 gr. 


0.3-0.6 gm. 


3-6 gr. 


0.2-0.4 gm. 


5-15 gr. 


0.3-1.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


5-30 gr. 


0.3-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-3 gr. 


0.06-0.18 gm. 


i-2 gr. 


0.03-0.12 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-1 fl. dr. 


2.0-4.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


10-60 min. 


0.6-4.0 cc. 


5-30 gr. 


0.3-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


\ dr. 


2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


3-6 gr. 


0.18-0.35 gm. 


15-30 min. 


1.0-2.0 cc. 


4-8 gr. 


0.25-0.5 gm. 


1-2 fl. dr. 


2.0-8.0 cc. 


5-20 gr. 


0.3-1.2 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


2-10 gr. 


0.12-0.6 gm. 


1-2 dr. 


4.0-8.0 gm. 


30-60 min. 


2.0-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


15-30 min. 


1 .0-2.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.65-2.0 cc. 



786 



DOSES OF MEDICINES. 



Remedy. 



Krameria 

extract of 

fluid extract of 

syrup of 

tincture of 

Lactucarium 

fluid extract of 

syrup of 

Lappa, fluid extract of 

Lead acetate 

iodide 

Leptandra 

extract of 

fluid extract of 

Leptandrin 

Lime, solution of 

syrup of 

Liquor potassse, soda?, etc. See Potassa, 

Soda, etc. 
Liquorice, compound mixture of 

powder of 

Lithium benzoate 

bromide 

carbonate 

citrate 

salicylate 

Lobelia, fluid extract of 

tincture of 

Lupulin 

fluid extract of 

oleoresin of 

tincture of 

Magnesia 

Magnesium carbonate 

sulphate 

sulphite 

Male fern, oleoresin of 

Malt, extract of 

Manganese binoxide 

sulphate : 

Manna 

Matico 

fluid extract of 

tincture of 

Matricaria, fluid extract of 

Menispermum, fluid extract of 

Menthol 

Mercury with chalk 

corrosive chloride of 

cyanide 

formamidate fl per cent, solution) . . . 

green iodide of 

mass of (blue pill) 

mild chloride of 

red iodide of 

salicylate 

tannate 

yellow subsulphate of 

Mezereum, extract of 

fluid extract of 

Morphine and its salts 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


10-20 gr. 


0.6-1.2 gm. 


5-15 gr. 


0.3-1.0 gm. 


20-30 min. 


1.2-2.0 cc 


1-4 fl. dr. 


4.0-16.0 cc. 


£-2 fl. dr. 


2.0-8.0 cc. 


10-15 gr. 


0.6-1.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1-3 fl. dr. 


4.0-12.0 cc. 


30-60 min. 


2.0-4.0 cc. 


i-3 gr. 


0.03-0.18 gm. 


*-3 gr. 


0.03-0.18 gm. 


20-40 gr. 


1.2-2.5 gm. 


3-10 gr. 


0.18-0.6 gm. 


30-60 min. 


2.0-4.0 cc. 


2-4 gr. 


0.12-0.25 gm. 


1-4 dr. 


4.0-15.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


i-l dr. 


2.0-4.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


1-5 min. 


0.06-0.3 cc. 


10-30 min. 


0.6-2.0 cc. 


5-10 gr. 


0.3-0.6 gm. 


10-15 min. 


0.6-1.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


|-2 fl. dr. 


2.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


2 dr.-l oz. 


8.0-32.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 gm. 


2-4 gr. 


0.12-0.25 gm. 


2-10 gr. 


0.12-0.6 gm. 


1-2 oz. 


32.0-64.0 gm. 


£-2 dr. 


2.0-8.0 gm. 


l-l fl. dr. 


2.0-4.0 cc. 


£-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


30 -60 min. 


2.0-4.0 cc. 


2gr. 


0.12 gm. 


2-10 gr. 


0.12-0.6 gm. 


*Wfr g r - 


0.002-0.004 gm. 


tW gr- 


0.004-0.00S gm. 


5-15 min. 


0.3-1.0 gm. 


*-* gr. 


0.01-0.03 gm. 


3-10 gr. 


0.2-0.6 gm. 


i~ 5 g r - 


0.008-0.3 gm. 


sWff g r - 


0.002-0.004 gm. 


£-! gr« 


0.03-0.06 gm. 


i-l gr. 


0.03-0.06 gm. 


J-l gr. 


0.015-0.06 gm. 


£-1 g r - 


0.03-0.06 gm. 


3-10 min. 


0.18-0.6 cc. 


A-i g r - 


0.004-0.03 gm. 



DOSES OF MEDICINES. 



787 



Remedy. 



Morrhuol 

Musk. 

tincture of 

Myrrh . 

tincture of 

Myrtol 

Naphthaline 

Naphthol 

Narceine 

Narcotine 

Nectandra, fluid extract of 

Nitroglycerin (1 per cent, solution) .... 
Nux vomica, abstract of 

extract of 

fluid extract of 

tincture of 

Opium, camphorated tincture of (paregoric) 

confection of 

extract of 

powder . . 

tincture of (laudanum) 

wine of 

Pancreatin 

Papaver, extract of 

fluid extract of 

Papayotin 

Paracotoi'n 

Paraldehyde 

Pareira 

extract of 

fluid extract of 

tincture of 

Pelletierine sulphate 

tannate 

Peppermint, oil of 

spirit of 

Pepsin, pure . . 

liquor of 

saccharated 

Petroselinum, fluid extract of 

Phenacetin . 

Phosphorated oil 

Phosphorus 

Physostigma, extract of 

fluid extract of . . . 

tincture of 

Physostigmine salicylate 

sulphate 

Phytolacca, abstract of 

berries, fluid extract of 

root, extract of . . 

fluid extract of 

tincture of 

Phytolaccin 

Picrotoxin 

Pilocarpine and its salts . . 

Pilocarpus, abstract of 

fluid extract of 

Pimenta, fluid extract of ....... . 

Piper methysticum, fluid extract of . . . . 

nigrum, fluid extract of 



Dose. 



Apothecaries' 
Weights and Measures. 



1-5 gr. 

2-15 gr. 
15-60 min. 
10-30 gr. 
15-30 min. 

2-3 gr. 

2-10 gr. 

2-10 gr. 

3gr. 
1-4 fl. dr. 
1 min. 

*-* gr- 

1-5 min. 
10-20 min. 

f-2 fl. dr. 
10-40 gr. 

Wgr. 

i-1 gr. 

5-30 min. 

5-30 min. 
10-20 gr. 

|-2 gr. 
15-30 min. 

1-5 gr. 

1-3 gr. 
20-60 min. 

f-ldr. 
10-30 gr. 

1-1 fl. dr. 
1 fl. dr. 

2-5 gr. 

1-5 gr. 

2-5 min. 
30-60 min. 
15 gr.-l dr. 

2-4 fl. dr. 
30 gr.-|- oz. 

1-2 fl. dr. 

2-5 gr. 

3-5 min. 
-fh-7i> gr. 

1 _1 or 

Te 6 g r - 

1-3 min. 

5-10 min. 
TTo - jo gr* 
rk-sV gr- 

5-15 gr. 

5-30 min. 

1-3 gr. 

5-30 min. 
10-60 min. 

2-3 gr. 

i _ i ~ r 

6 4^3 2 gr- 

*W gr- 
5-20 gr. 
15-60 min. 
15-45 min. 
15 min.-l fl. dr. 
15-45 min. 



Metric 
System. 



0.06-0.03 gm. 

0.1-1.0 gm. 

1.0-4.0 cc. 

0.6-2.0 gm. 

1.0-2.0 cc. 
0.12-0.18 gm. 
0.12-0.6 gm. 
0.12-0.6 gm. 
0.01-0.03 gm. 
0.18 gm. 

4.0-16.0 cc. 
0.06 cc. 
0.015-0.06 gm. 
0.008-0.03 gm. 
0.06-0.3 cc. 

0.6-1.2 cc. 

2.0-8.0 cc. 

0.6-2.5 gm. 

0.01-0.03 gm. 

0.015-0.06 gm. 

0.3-2.0 cc. 

0.3-2.0 cc. 

0.6-1.2 gm. 
0.03-0.12 gm. 

1.0-2.0 cc. 
0.06-0.3 gm. 
0.06-1.18 gm. 

1. 2-4.0 cc. 

2.0-4.0 gm. 

0.6-2.0 gm. 

2.0-4.0 cc. 
4.0 cc. 
0.12-0.3 gm. 

0.6-0.3 gm. 
0.12-0.3 cc. 

2.0-4.0 cc. 

1.0-4.0 gm. 

8.0-15.0 cc. 

2.0-16.0 gm. 

4.0-8.0 cc. 

0.12-0.3 gm. 

0.18-0.3 cc. 

0.0006-0.0008 gm. 

0.004-0.01 gm. 

0.06-0.18 cc. 

3-0.6 cc. 
0.0005-0.0008 gm. 
0.0005-0.0008 gm. 

0.3-1.0 gm. 
0.12-2.0 cc. 
0.06-0.18 gm. 

0.3-2.0 cc. 

0.6-4.0 gm. 

0.12-0.18 gm. 

0.001-0.002"gm. 

0.001-0.03 gm. 

0.3-1.2 gm. 

1.0-4.0 cc. 

1.2-3.0 cc. 
. 1.0-4.0 cc. 

1.0-3.0 cc. 



788 



DOSES OF MEDICINES. 



Remedy. 



Piper nigrum, oleoresin of ... . 

Piperine 

Piscidia erythrina, extract of - . . 
fluid extract of ....... . 

powder of 

Podophyllum, abstract of 

resin of 

Pomegranate, bark of 

Poppy. See Papaver. 

Potassa, solution of (liquor potassae) 

Potassium acetate 

bicarbonate 

bitartrate 

bromide 

carbonate 

chlorate 

citrate 

solution of 

cyanide 

ferrocyanide 

hypophosphite 

iodide 

mixture of the citrate of ... . 

nitrate 

permanganate 

and sodium tartrate 

sulphate 

sulphide 

sulphite 

tartrate 

Prinos 

fluid extract 

Pulsatilla, fluid extract of 

Pyrethrum, tincture of 

Pyridine 

Pyrodine 

Quassia, extract of 

fluid extract of 

tincture of 

Quebracho, fluid extract of ... . 

Quercus, fluid extract of 

Quinidine 

Quinine and salts 

arsenate 

Quinoidin 

Resorcin 

Khamnus catharticus, fluid extract of 
Rhubarb 

aromatic syrup of ..... . 

tincture of . 

compound powder of 

extract of 

fluid extract of 

and soda, mixture of 

sweet tincture of 

syrup of 

tincture of 

wine of 

Rhus, aromatic fluid extract of . . . 

glabra (cortex), fluid extract of . 
(fructus), fluid extract of . . . 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-3 gr. 


0.06-0.2 gm. 


1-8 gr. 


0.06-0.5 gm. 


1-2 gr. 


0.06-0.12 gm. 


10-30 min. 


0.6-2.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


1-5 gr. 


0.6-0.3 gm. 


1-1 gr- 


0.008-0.03 gm. 


20-30 gr. 


1.2-2.0 gm. 


5-20 min. 


0.3-1.2 cc. 


15 gr.-l dr. 


1.0-4.0 gm. 


10-40 gr. 


0.6-2.5 gm. 


1-5 gr. 


0.06-0.3 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


5-30 gr. 


0.3-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


15-60 gr. 


1.0-4.0 gm. 


2-4 fl. dr. 


8.0-16.0 cc. 


T6-1 g r - 


0.004-0.008 gm. 


10-15 gr. 


0.6-1.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


2-15 gr. 


0.12-1.0 gm. 


i fl. oz. 


15.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


1-2 gr. 


0.06-0.12 gm. 


^-1 oz. 


15.0-30.0 gm. 


30 gr.-2 dr. 


2.0-8.0 gm. 


1-10 gr. 


0.06-0.6 gm. 


15-30 gr. 


1.0-2.0 gm. 


1 dr.-l oz. 


4.0-32.0 gm. 


30 gr.-l dr. 


2.0-4.0 cc. 


30-60 min. 


2.0-4.0 cc. 


2-5 min. 


0.12-0.3 cc. 


10-30 min. 


0.6-2.0 cc. 


1-3 gr. 


0.06-0.18 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-5 gr. 


0.06-0.3 gm. 


30-60 min. 


2.0-4.0 cc. 


£-2 fl. dr. 


2.0-8.0 cc. 


20-60 min. 


1.2-4.0 cc. 


30-60 min. 


2.0-4.0 cc. 


1-30 gr. 


0.06-2.0 gm. 


1-30 gr. 


0.06-2.0 gm. 


fr-1 ^. 


0.01-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-10 gr. 


' 0.3-0.6 gm. 


30-60 min. 


2.0-4.0 cc. 


2-30 gr. 


0.12-2.0 gm. 


1-4 fl. dr. 


4.0-16.0 cc. 


l-l fl. dr. 


2.0-4.0 cc. 


4-1 dr. 


2.0-4.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


15-40 min. 


1.0-2.5 cc. 


4-1 fl. dr. 


.2.0-4.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


15-60 min. 


1 .0-4.0 cc. 


30-60 min. 


2.0-4.0 cc 


30-60 min. 


2.0-4.0 cc. 



LOSES OF MEDICINES. 



789 



Remedy. 



Rhus toxicodendron 

Roses, fluid extract of 

syrup of 

Rubus, fluid extract of 

Rnraex, fluid extract of 

Ruta, fluid extract of 

Sabina, fluid extract of 

Saccharin ! 

Salicin 

Salix, fluid extract of 

Salol 

Salvia, fluid extract of 

Sambucus, fluid extract of 

Sandal-wood, oil of ... 

Sanguinaria 

fluid extract of 

tincture of 

Santonica 

fluid extract of 

Santonin 

Sarsaparilla, compound fluid extract of 

compound syrup of 

fluid extract of 

Sassafras, fluid extract of 

Savine, oil of 

Scammony 

resin of 

Scoparius, fluid extract of 

Scutellaria, fluid extract of 

Scutellarine 

Senega, abstract of 

fluid extract of 

syrup of 

Senna 

compound infusion of 

confection of ; . . 

fluid extract of 

infusion of 

syrup of 

tincture of 

Serpentaria, fluid extract of .... 

tincture of 

Silver iodide . 

nitrate 

oxide 

Simaruba, fluid extract of 

Soda, solution of (liquor sodse) .... 
Sodium acetate 

arsenate 

benzoate 

bicarbonate 

bisulphite 

borate 

bromide 

carbonate ... 

chlorate 

citrate 

hypophosphite 

hyposulphite 

iodide 

nitrite - 



Dose. 


Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-6 min. 


0.06-0.4 gm. 


1-2 fl. dr. 


2.0-8.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-2 fl. dr. 


2.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-15 min. 


0.3-1.0 cc. 


z~4 gr- 


0.03-0.25 gm. 


10-30 gr. 


0.6-2.0 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


10-20 gr. 


0.6-1.2 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


|-2 fl. dr. 


2.0-8.0 cc. 


15-20 min. 


1.0-1.2 cc. 


1-5 gr. 


0.06-0.3 gm. 


5-10 min. 


0.3-0.6 cc. 


10-40 min. 


0.6-2.5 cc. 


10-30 gr. 


0.6-2.0 gm. 


15-60 min. 


1.0-4.0 cc. 


1-4 gr. 


0.06-0.25 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


2-5 min. 


0.12-0.3 cc. 


5-15 gr. 


0.3-1.0 gm. 


2-10 gr. 


0.12-0.6 gm. 


i-1 fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-3 gr. 


0.06-0.18 gm. 


4-10 gr. 


0.25-0.6 gm. 


8-15 min. 


0.5-1.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


10-60 gr. 


0.6-4.0 gm. 


1-2 oz. 


32.0-64.0 gm. 


1-2 dr. 


4.0-8.0 gm. 


1-4 fl. dr. 


4.0-15.0 cc. 


4 fl. oz. 


125.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


2 fl. dr.-l fl. oz. 


8.0-30.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


2.0-8.0 cc. 


i-2 gr. 


0.03-0.12 gm. 


Hr gr- 


0.015-0.03 gm. 


£-1 gr. 


0.03-0.06 gm. 


15-30 min. 


1.0-2.0 cc. 


5-20 min. 


0.3-1.2 cc. 


15 gr.-l dr. 


1.0-4.0 gm. 


¥o — To gr« 


0.001-0.006 gm. 


5-30 gr. 


0.3-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-30 gr. 


0.3-2.0 gm. 


1-10 dr. 


4.0-40.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-20 gr. 


0.3-1.2 gm. 


1-4 gr. 


0.06-0.25 gn* 



790 



DOSES OF MEDICINES. 



Remedy. 



Sodium phosphate 

salicylate 

sulphate 

sulphite 

Sparteine sulphate 

Spigelia, fluid extract of . . . . 

and senna, fluid extract of . . 
Squill, compound fluid extract of 
syrup of 

fluid extract of 

syrup of 

tincture of 

Stillingia, fluid extract of . . . 
Stramonium, extract of . . 

fluid extract of 

leaves, alcoholic extract of . 
tincture of ...... . 

seeds, extract of 

tincture of 

Strontium bromide 

iodide 

lactate 

phosphate 

Strophanthus, tincture of . . . 

Strophantin 

Strychnine and its salts .... 

Sulphonal 

Sulphur 

Sumbul, fluid extract of ... . 

tincture of 

Taraxacum, extract of ... . 

fluid extract of 

Terebene 

Terpine hydrate 

Terpinol 

Thallin, sulphate of 

tartrate of 

Theine 

Thuja, fluid extract of ... . 

Thymol 

Toxicodendron, fluid extract of 
Triticum, fluid extract of . • • 

Turpentine, oil of 

Urethane 

Ustilago maidis, fluid extract of 
Uva ursi, fluid extract of . . . 
Valerian, abstract of 

ammoniated tincture of . . - 

extract of 9 . . . . 

fluid extract of 

oil of 

tincture of 

Veratrine 

Vcratrum viride, abstract of . . 

fluid extract of 

tincture of 

Verbena, fluid extract of . . . 
Viburnum, fluid extract of . . 
Vinegar. See Acetvm. 
Wahoo. Sec Ekum/yrnvs. 
Wild-cherry bark 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-10 gr. 


0.12-0.6 gm. 


10-20 gr. 


0.6-1.2 gm. 


1-4 dr. 


4.0-16.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


2V g r - 


0.002 gm. 


15-60 min. 


1.0-4.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


5-30 min. 


0.3-1.8 cc. 


15-30 min. 


1.0-2.0 cc. 


5-30 min. 


0.3-1.8 cc. 


i-l fl. dr. 


2.0-4.0 cc. 


10-60 min. 


0.6-4.0 cc. 


15-60 min. 


1.0-4.0 cc. 


ig r - 


0.03 gm. 


1-4 min. 


0.06-0.25 cc. 


Hgr. 


0.015-0.03 gm. 


8-15 min. 


0.5-1.0 cc. 


i-l gr- 


0.015-0.03 gm. 


6-15 min. 


0.4-1.0 cc. 


20-30 gr. 


1.2-2.0 gm. 


10-20 gr. 


0.6-1.2 gm. 


20-30 gr. 


1.2-2.0 gm. 


20-30 gr. 


1.2-2.0 gm. 


3-8 min. 


0.2-0.5 cc. 


T?0~6 o g r - 


0.0005-0.001 gm. 


6T-T6 g 1 "- 


0.001-0.004 gm. 


15-30 gr. 


1.0-2.0 gm. 


1-3 dr. 


4.0-12.0 gm. 


15-60 min. 


1.0-4.0 cc. 


10-30 min. 


0.6-2.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


i-1 fl. dr. 


2.0-4.0 gm. 


5-10 min. 


0.3-0.6 cc. 


2-5 gr. 


0.12-0.03 gm. 


To g r - 


0.003 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-2 gr. 


0.06-0.12 gm. 


10-15 gr. 


0.6-1.0 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-5 min. 


0.06-0.3 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


5-30 min. 


0.3-2.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


15-60 min. 


1.0-4.0 cc. 


i-1 fl. dr. 


2.0-4.0 cc. 


10-15 gr. 


0.6-1.0 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


£-1 fl. dr. 


2.0-4.0 cc. 


4-5 min. 


0.24-0.3 cc. 


|-2 fl. dr. 


2.0-8.0 cc. 


?Wl7 g r - 


0.001-0.003 gm. 


1-2 gr. 


0.06-0.12 gm. 


1-5 min. 


0.06-0.3 cc. 


3-5 min. 


0.18-0.3 cc. 


15-60 min. 


1.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


H dr. 


2.0-4.0 gm. 



DOSES OF MEDICINES. 



791 



Remedy. 



Wild-cherry bark, fluid extract of . 

infusion of 

syrup of 

Wintergreen, oil of 

Wormseed, oil of . . . . • • - • • 
Xanthoxylum bark, fluid extract of, 

fruit, fluid extract of 

Zinc acetate 

bromide 

iodide 

oxide 

phosphide 

sulphate (alterative) 

(emetic) 

syrup of iodide of 

valerianate 

Zingiber. See Ginger. 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. oz. 


30.0-60.0 cc. 


2-4 fl. dr. 


8.0-16.0 cc. 


1-20 min. 


0.06-1.2 cc. 


4-8 min. 


0.24-0.5 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-2 gr. 


0.06-0.12 gm. 


1-2 gr. 


0.03-0.12 gm. 


£-3 gr. 


0.03-0.18 gm. 


2-8 gr. 


0.12-0.5 gm. 


to-tV gr- 


0.003-0.006 gm. 


i-1 gr. 


0.015-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 


20-40 min. 


1.2-2.5 cc. 


1-4 gr. 


0.06-0.2 gm. 



INDEX OF DRUGS AND! REMEDIAL MEASURES. 



A BDOMINAL TRANSFUSION, 507 
li Abortifacients, 37 
Abrin, 282 

Absolute alcohol, 61, 67 
Absorption of drugs, 33 
Abstract of aconite, 60 
Abstracts, 25 
Acacia, 51 
Acacise gummi, 51 
A. C. E. mixture, 175 
Aceta, 25 
Acetanilid, 51 
Acetanilidum, 51 
Acetate of ammonium, 76 

of lead, 287 

of morphine, 344 

of potassium, 56 

of sodium, 396 

of zinc, 430 
Acetic acid, 56 
Acetum, 56 

ipecacuanha?, 274 

lobelias, 293 

opii, 342 

sanguinarise, 387 

scillse, 401 
Acid hydrochloride of quinine, 183 

infusion of roses, 378 

nitrate of mercury, 311 

picric, 362 

tartrate of potassium, 113 
Acidum aceticum, 56 
dilutum, 56 
glaciale, 56 

arseniosum, 95, 99 

arsenosum, 95, 99 

benzoicum, 110 

boricum, 114, 438 

carbolicum, 140 

liquefactum, 144 

chromicum, 176 

citricum, 186 

gallicum, 238 

hydrobromicum dilutum, 121 

hydrochloricum, 253 
dilutum, 253 

hydrocyanicum, 254 
dilutum, 254 

nitricum, 323 
dilutum, 323 
fumans, 324 

nitro-hydrochloricum, 254, 326 
dilutum, 254, 326 

phosphoricum concentratum, 358 
dilutum, 358 

salicylicum, 380 

sulphuricum, 408 
aromaticum, 409 



Acidum sulphuricum dilutum, 409 

tannicum, 412 

tartaricum, 414 

trichloraceticum, 421 

valerianicum, 425 
Acoine, 57 
Aconine, 57 
Aconite, 57 

liniment, 60 

ointment, 60 
Aconitina, 60 
Aconitine, 57, 60 

oleate, 59 

Duquesnel's crystalline, 60 
Action of drugs, direct, 21 
duration of, 33 
indirect, 21 
modes of, 21 
Acupuncture, 433 
Adeps benzoinatus, 110 

lanse hydrosus, 284 
Adhesive plaster, 375 
Administering drugs, modes of, 21 
Adonidin, 60 
Adonis vernalis, 60 
Adrenalin, 410 
vEther, 223 

purificatus, 223 
Agaric, 61 
Agaricin, 61 
Alcohol, 61, 67 

absolutum, 61, 67 

amylicum, 61, 67 

deodoratum, 61, 67 

dilutum, 61, 67 

ethylicum, 61 

phenylic, 140 
Ale, 67 
Alkaloids, 25 
Allis ether inhaler, 228 
Allium, 67 

-juice, 68 

sativum, 67 

syrup of, 68 
Allspice, 68 
Almond bread, 68, 519 
Almonds, 68 

bitter, 68 

sweet, 68 
Aloe, 69 

barbadensis, 69 

purificata, 71 

socotrina, 69 
Aloes, 69 
Aloin, 69 
Aloinum, 69 
Alteratives, 38, 43 
Alum, 71 

793 



794 



INDEX OF DRUGS. 



Alumen, 71 

exsiccatum, 72 
Amber, 73 

American wormseed, 150 
Ammonia, 73 

liniment, 75 
Ammoniac, 75 
Ammouiacum, 75 
Ammoniated mercury, 305 

tincture of ergot, 222 
of guaiac, 245 
of opium, 343 
of quinine, 183 
of valerian, 425 
Ammonii acetas, 76 

benzoas, 76 

bromidum, 76 

carbonas, 77 

cbloridum, 77 

iodidum, 78 

oxalas, 79 

phosphas, 79 

sulphas, 79 

sulphis, 79 

valerianas, 79, 425 
Ammonio-ferric alum, 275 
Ammonium, 76 
Amygdala amara, 68 

dulcis, 68 
Amygdalin, 373 
Amylic alcobol, 61 
Amyl nitris, 79 

nitrite, 79 
Amylum, 401 

Anaesthesia by infiltration, 190 
Anaesthetics, 38, 43 
Anaphrodisiacs, 38 
Antacids, 38, 43 
Anthelmintics, 38, 43 
Anthrarobin, 81 
Antiarthritics, 38 
Antidotum arsenici, 100, 278, 294 
Antifebrin, 51 
Antihydrotics, 38 
Antimalarials, 44 
Antimonial powder, 81, 86 
Antimonii oxiduin, 81 

et potassii tartras, 81, 82 

sulphidum, 81 

purificatum, 81 
Antimonium nigrum purificatum, 81 

sulphuratum, 81 

tartaratum, 81, 82 
Antimony, 81 
Antiperiodics, 38, 44 
Antiphlogistics, 38 
Antipyretics, 44 
Antipyrin, 86 
Antiseptics, 44, 434 
A 1 1 1 ispasmodics, 44 
Antistreptococcic serum, 441 
Antitoxin, 439 

for diphtheria, 440 
Aphrodisiacs, 38 
Apiol, 91 
Apocynum, 92 

androsimsefolinro, 92 

cannabinuin, 92 
Apomorphinse hydrochloras, 94 

hydrochloridum, 94 
Apomorphine, !»'-' 



Apothecaries' measure, 29 

weight, 29 
Aqua arnruoniae, 75 
fortior, 75 

amygdalae amarae, 69 

camphorae, 133 

chloroformi, 171, 176 

cinnamomi, 186 

creosoti, 207 

hydrogenii dioxidi, 256 

menthae piperitae, 352 

pimentae, 68 

rosae, 378 
Aquae, 25 
Arbutin, 425 
Argenti nitras, 319 
dilutus, 322 
fusus, 319 
mitigatus, 322 
Argyria, 320 
Aristol, 94, 417 
Aristolochin, 394 
Arnica, arnicae, 94 

flores, 94 

radix, 94 

rhizoma, 94 
Aromatic chalk powder, 129 
with opium, 129 

mixture of iron, 275 

powder, 146, 186 

spirit of ammonia, 75 

sulphuric acid, 409 

syrup of cascara, 146 
of rhubarb, 377 

tincture of rhubarb, 377 
Arsenate of iron, 275 

of sodium, 99 
Arsenic, 95 
Arsenicum, 95 
Arseni iodidum, 99 
Arsenous acid, 95, 99 
Artificial milk, 520 
Asafetida, 101 
Asafoetida, 101 
Aspidium, 101 

filix-mas, 101 
Aspirin, 102 
Astringents, 38, 44 

mineral, 44 

vegetable, 44 
Atomization, 24 .. 
Atropinae sulphas, 104, 109 
Atropine, 104 
Auranine, 314 
Auri et sodii chloridum, 244 
Avoirdupois weight, 30 
Azedarach, 102 

BALM OF GILEAD," 422 
Balsam of copaiba, 203 
Barbadoes aloes, 69 
Barium chloride, 103 
Barley-water, 518 
Basham's mixture, 275, 276 
Bath, Brand, 453 

Russian, 477 

stretcher, 454 

Turkish, 474 
Bearberry, 424 
Beechwood creosote, 205 
Beef essence, 518 



INDEX OF DRUGS. 



795 



Beef, peptonized, 514 

-tea, 517 
Beer, 67 
Belladonna, 103 
folia, 103 
liniment, 109 
ointment, 109 
plaster, 109 
radix, 103 
suppositories, 109 
Benzaconine, 57 
Benzoate of ammonium, 76 
of bismuth, 111 
of lithium, 292 
Benzoated lard, 110 
Benzoic acid, 109, 110 
Benzoin, 109 
Benzoinum, 109 
Benzonaphtol, 318 
Berberine, 130, 252 
Beta-eucaine, 233 
Beta-naphthol, 318 

bismuth, 318 
Bicarbonate of potassium, 372 

of sodium, 396 
Bichloride of mercury, 305 

as an antiseptic, 434 
Bidet, the, 446 

Bimuriate of quinine and urea, 184 
Biniodide of mercury, 307 
Binoxide of manganese, 296 
Bismuth, 110 

and ammonium citrate, 110 
benzoate, 111 
citrate, 110 
salicylate, 112 
subcarbonate, 110 
subgallate, 112 
subnitrate, 110 
Bismuthi et ammonii citras, 110 
carbonas, 111 
citras, 110 
oxidum, 111 
salicylates, 112 
subcarbonas, 110 
subnitras, 110 
Bisulphate of quinine, 183 
Bitartrate of potassium, 113 
Bitter almonds, 68 

wine of iron, 281 
Bitters, 37 
Black cohosh, 177 
draught, 393 
drop, 342 
ginger, 241 
mustard, 316 
oxide of manganese, 296 
pepper, 351 
snake-root, 177 
wash, 307 
Bl ami's pill, 276 
Bleeding, 507 
Blisters. 460 

figures showing the areas to apply, 
461, 462 
Blood-root, 387 
Blue-mass, 307 
ointment, 310 
pill, 307 
Bone-marrow, 242 
Boneset, 234 



Bonjean's ergotin, 222 

Borate of sodium, 113 

Borated lint, 114 

Borax, 113 

Boric acid, 113, 114, 438 

Boroglycerin, 115 

Bran bread, 519 

Brand bath, 453. 

Brandy, 67 

Brayera, 210 

Bromide of ammonium, 76 

of calcium, 120, 127 

of ethyl, 229 

of gold, 121 

of iron, 276 

of lithium, 121, 292 

of nickel, 121 

of potassium, 115 

of sodium, 121 

of strontium, 403 
Bromides, 115 
Bromine, 122 
Bromoform, 122 
Bronchitis tents, 478, 555 
Broom, 391 
Brown mixture, 291 
Brucine, 330 
Bryonia, 122 
Bryony, 122 
Buchu, 123 

folia, 123 
Burgundy pitch, 368 
Butyl chloral hydras, 208 

pACODYLATE OF IKON, 276 
\J of sodium, 397 
Cactus grandiflorus, 124 
Caffea, 124 
Caffeina, 124, 126 

citrata, 124 

effervescens, 125 
Caffeinse citras, 124 

effervescens, 125 
Caffeine, 124 ' 
Cajuput oil, 127 
Calabar bean, 361 
Calabarine, 361 
Calamine, 430 
Calcii bromidum, 120, 127 

carbonas prsecipitatus, 127 

chloridum, 127 

hydras, 131 

hypophosphis, 127 

phosphas, 127 

prsecipitatus, 127 

sulphas, 127, 129 
Calcined magnesia, 294 
Calcium, 127 

oxide, 130 
California buckthorn, 146 
Calomel, 307 

ointment, 310 
Calumba, 130 

radix, 130 
Calumbine. 130 
Calumbo, 130 
Calx, 130 

chlorata, 159 

chlorinata, 159 

sulphurata, 131 
Camphor, 131 



796 



INDEX OF DRUGS. 



Camphor liniment, 133 
monobromate, 133 
-water, 133 
Caniphora, 131 

monobromata, 133 
Camphorated alcohol, 133 
oil, 132 

tincture of opium, 342 
Camphoric acid, 134 
Canada pitch, 368 
Cannabis indica, 134 
Cantharidal cerate, 138 
collodion, 138, 200 
Cautharidin, 137 
Cantharis, 137 
Capsici fructus, 139 
Capsicine, 139 
Capsicum, 139, 463 
fruit, 139 
plaster, 140 
Carbolic acid, 140 

as an antiseptic, 435 
ointment, 144 
Carbo ligni, 144 
Carbon, 144 

Carbonate of ammonium, 77 
of bismuth, 111 
of creosote, 207 
of guaiacol, 247 
of iron, 275, 276 
of lead, 288 
of lithium, 291 
of magnesium, 294 
of potassium, 372 
of zinc, 430 
Cardamom, 145 

seed, 145 
Cardamomum, 145 
Cardiac sedatives, 39, 44 

stimulants, 39, 44 
Carminative powder, 185 
Carminatives, 39 
Carron oil, 131, 237 
Caryophylluni, 187 
Caryophyllus, 187 
Cascara cordial, 146 

evacuant, 146 
sagrada, 146 
Cassise pulpa, 146 
Cassia fistula, 146 
Castile soap, 394 
Castor oil, 147 
Cataphoresis, 25 
Cataplasma carbon is, 144 
Cataplasms, 25 
Catechu, 149 
Cathartics, 39, 46 
Cat's-hair, 235 
Caustic potash, 149 

soda, 150 
Cayenne pepper, 139 

( 'crates, 2.") 

Ccratum camphorse, 133 

cantharidis, 138 

plumbi subacetatis, 289 

resinse, 375 
Cerebral extracts, 242 
Cerii oxalas, 150 
( lerium oxalate. 150 

Chalk, 121) 

mixture, 127 



Chamber inhaler, 486 
Champagne, extra dry, 66 
Charcoal, 144 

poultice, 144 
Charta potassii nitratis, 319 

sinapis, 317 
Chartse, 25 
Chenopodium, 150 
Chimaphila, 150 
Chinoidinum, 185 
Chirata, 151 
Chireta, 151 
Chloral, 151 

hydras, 151 
Chloralamide, 155 
Chloralose, 156 
Chlorate of potassium, 156 
Chloretone, 158 
Chloride of ammonium, 77 

of barium, 103 

of calcium, 127 

of ethyl, 230 

of gold and sodium, 244 

of iron, 275, 277 

of mercury, corrosive, 305 
mild, 307 

of methyl, 314 

of methylene, 315 

of sodium, 397 

of zinc, 431 

as an antiseptic, 438 
Chlorinated lime, 159, 468 
Chlorine gas, 159 
Chlorobrom, 156 
Chlorodyne, 159 
Chloroform, 160 

inhaler, Esmarch's, 170 

liniment, 176 

-water, 171, 176 
Chloroformum, 160 

purificatum, 160 

venale, 160 
Cholagogues, 39 
Chromic acid, 176 
Chrysarobin, 177 

ointment, 177 
Chrysarobin um, 177 
Cimicifuga, 177 

racemosa, 177 

rhizoma, 177 
Cinchona, 178 

calisaya, 178 

condaminea, 178 

micrantha, 178 

pale, 178 

pitayensis, 178 

red, 178 

rubra, 178 

cortex, 178 

succirubra, 178 

yellow, 178 
Cinchoniciue, 178 
Cinchonidina sulphas, 185 
Cinchonidine, 178, 185 
Cinchouinae sulphas, 185 
Cinchonine, 178 
Cinnamic acid, 186 
Cimiamomum cassia, 185 

cortex. 185 
Cinnamon, 185 

•water, 1H6 



INDEX OF DRUGS. 



797 



Citrate of bismuth, 110 

and ammonium, 110 

of caffeine, 124 

of iron, 275, 277 

and ammonium, 277 
and quinine, 277 
and strychnine, 277 

of lithium, 291 

of magnesium, 295 

of potassium, 372 
Citrated caffeine, 124 
Citric acid, 186 
Citrine ointment, 312 
Citrophen, 357 
Classification of drugs, 43 
Climates, 500 
Cloves, 187 
Clyster, 23 

Cobalto-nitrate of potassium, 324 
Coca, 187 

folia, 187 
Cocaina, 187 
Cocainse hydrochloras, 187, 189 

hydrochloridum, 187, 189 
Cocaine, 187 
Codeina, 194 
Codeinse phosphas, 194 
Codeine, 194, 335 

phosphate, 194 

sulphate, 194 
Cod-liver oil, 194 
Coffee, 124, 197 
Colchici cormus, 197 

radix, 197 

semen, 197 

semina, 197 
Colchicine, 197, 199 
Colchicum, 197 

corms, 197 

root, 197 

seed, 197 
Cold bath, 449 

cream, 378 

in fevers, 452 

pack, 456 

as a remedy, 442 
Collodion. 199 
Collodium, 199 

cantharidatum, 138, 200 

flexile, 199 

stypticum, 200, 413 

vesicans, 138, 200 
Colocynth, 200 
Colocynthidis pulpa, 200 
Cologne-water, 67 
Columba, 130 
Columbic acid, 130 
Columbine, 130 
Columbo, 130 

Combination of drugs for joint effect, 34 
Commercial oxide of zinc, 346 
Compound cathartic pill, 200 

decoction of aloes, 71 
of sarsaparilla, 389 

effervescing powder, 392 

elixir of kola, 284 

extract of colocynth, 200, 390 

fluid extract of sarsaparilla, 389 

infusion of gentian, 241 
of senna, 297, 393 

liniment of mustard, 317 



Compound mixture of iron, 276 
of liquorice, 291 
of senna, 393 
pill of antimony, 86 
of colocvnth, 200 
of rhubarb, 377 
of scammony, 390 
of soap, 343 
of squill, 401 
powder of almonds, 69 
of catechu, 149 
of chalk, 129 
of cinnamon, 186 
of elaterin, 219 
of ipecac, 274 
of jalap, 282 
of kino, 284 
of liquorice, 291, 393 
of morphine, 344 
of opium, 343 
of rhubarb, 377 
of scammony, 390 
solution of iodine, 268 
spirit of ether, 249 
of juniper, 283 
suppositories of lead, 288 
syrup of sarsaparilla, 389 

of squill, 86, 401 
tincture of benzoin, 110 
of camphor, 133, 342 
of cardamom, 146 
of catechu, 149 

of chloroform and morphine, 176 
of cinchona, 185, 394 
of gentian, 241 
of senna, 393 
Condurango, 201 
Confectio piperis, 351 
rosse, 251, 378 

gallicse, 378 
sennse, 147, 393, 412 
sulphuris, 408 
Confections, 26 
Conii folia, 201 
fructus, 201 
Conine, 201 
Conium, 201 
Conserves, 26 
Constipation, 576 
Contraindications for drugs, 37 
Convallamarin, 203 
Convallaria, 202 
Convolvulin, 281 
Cool sponging, 453 

Co-ordinated movements for treating loco- 
motor ataxia and myelitis, 458 
Copaiba, 203 
Copper, 204 
Cor nu tine, 220 
Corrosive chloride of mercury, 305 

sublimate, 305 
Cosmoline, 355 
Cotarnine, 205 

hydrochlorate, 205 
Counter-irritants, 39, 44 

-irritation, 459 
Coxe's hive-syrup, 86, 392, 401 
Cream of tartar, 113 
Creolin, 208 

as an antiseptic, 437 
Creosotal, 207 



798 



INDEX OF DRUGS. 



Creosote, 205 

carbonate, 207 

inhaler, Yeo's, 206 
Cresol, 205 
Creta praeparata, 129 
Croton chloral, 208 

oil, 209 

liniment, 209 
Croup kettle, 487 
Cubeba, 209 
Cubebic acid. 209 
Cubebin, 209 
Cubebs, 209 

Cumulative action of drugs, 34 
Cupping, 464 
Cupri sulphas, 204 
Cuprum, 204 
Cups, dry, 464 

applied. 464 

wet, 464 
Curds and whey, 354 
Cusso, 210 
Cyanide of potassium, 210 

DANDELION, 414 
Daturine, 402 
Deadly night-shade, 103 
Decoction of azedarach, 102 

of chimaphila, 151 
Decoctions, 26 
Decoctum aloes compositum, 71 

granati corticis, 371 

hsematoxyli, 247 

sarsapariilse compositum, 389 

scoparii, 392 
Definition of drugs, 37 

of therapeutics, 17 
Demulcents, 39 

Denison's resistance inhaler, 486 
Deodorized alcohol, 61, 67 

opium, 342 

tincture of opium, 342 
Dermatol, 112, 210 
Diabetin, 290 
Diachylon, 289 
Dialyzed iron, 278 
Diaphoretics, 39, 45 
Diastase, 210 

Diet for child six to twelve months old, 
517 
one year old, 517 
seven years old, 516 
two years old, 517 

importance of, in disease, 19 

lists, 516 
Dietetic treatment, importance of, 47 
Diethyl-sulphon-dimetbyl-methane, 405 
Digestants, 45 
Digested £ruel, 516 
Digitalein, 211 
Digitalin, 211 
Digitalis, 211 

folia, 211, 217 
Digitin, 211 
Digitonin, 211 
Digitoxin, 211 
I )ilutc acetic acid, 56 

alcohol. 61. 07 

hydrobromic acid, 121 

hydrochloric acid. 253 

hydrocyanic acid. 254 



Dilute nitric acid, 324 

nitro-hydrochloric acid, 254, 326 

phosphoric acid, 358 

solution of subacetate of lead, 289 

sulphuric acid, 409 
Diphtheria antitoxin, 440 
Direct action of drugs, 21 
Disinfectants, 45 
Disinfection, 465 
Diuretics, 39, 45 
Diuretin, 395 
Dobell's solution, 114 
Donovan's solution, 99 
Dormiol, 218 
Dosage, 27 

hypodermic, 28 

by the rectum, 28 

Young's rule of, 27 
Dover's powder, 273, 343 
Dried alum, 72 

sulphate of iron, 280 
Drip-sheet, 450, 451 
Drugs, absorption of, 33 

classification of, 43 

combination of, for joint effect, 34 

duration of action of, 33 

indications and contraindications for, 
37 

modes of action of, 21 
of administering, 21 

strength and reliability of, 35 
Dry cups, 464 

applied, 461 

heat, 479 
Duboisine, 218 

Duquesnel's crystalline aconitine, 60 
Duration of action of drugs, 33 

ECBOLIC ACID, 220 
Ecgonine, 187 
Effervescing citrate of caffeine, 125 
of lithium, 291 
of magnesium, 295 
of potassium, 373 

draught, 372 

powder, 396 

sulphate of sodium, 398 
Egg-flip, 67 

-nog, 66 
Elaterin, 219 
Elaterinum, 219 
Elaterium, 219 
Electuaries, 26 
Elimination in disease, 19 
Eliminators, 40, 45 
Elixir kolse composita, 284 

phosphori, 361 

proprietatis, 71 

roborans, 185 
Elixirs, 26 
Emetics, 40, 45 

direct, 40, 45 

peripheral, 40, 45 
Emetine, 271, 274 
Emmenagogues, 40, 45 

direct, 40, 45 

indirect, 40, 45 
Emplastra, 26 

Emplastrum ammoniac] cum hydrargyro, 
76 

arnicsB, 94 



INDEX OF DRUGS. 



799 






Emplastrum asafcetida?, 101 

belladonna?, 109 

cantharidis, 138 

capsici, 140 

ferri, 281 

hydrargyri, 311 

menthol, 353 

opii, 343 

picis, 368 

burgundica?, 368 
canadensis, 369 
cantharidatuni, 138, 368 

plurubi, 289 
iodidi, 288 

resina?, 289, 375 

saponis, 395 
Emulsin, 68, 373 
Emulsion of asafcetida, 101 

of bitter almonds, 69 

of sweet almonds, 69 
Emulsions, 26 
Emulsum ammoniaci, 76 

amygdala?, 69 

asafcetida?, 101 

chloroformi, 176 
Endermic medication, 25 
Enema, 23 

nutrient, 23 

peptonized, 515 
Euteroclysis, 468 
Epispastics, 44, 460 
Ergot, 220 
Ergotic acid, 220 
Ergotin, 220 
Ergotinic acid, 220 
Ergotinum, 222 
Erigeron, 223 

Erythrol tetranitrate, 223, 326 
Erythroxylon, 187 
Escharotics, 44 
Eserine, 361 

Esmarch's chloroform inhaler, 170 
Ether, 223 

inhaler, Allls, 228 
Ethyl alcohol, 61 

bromide, 229 

chloride, 230 
inhaler, 231 

iodide, 232 
Ethylate of sodium, 397 
Eucaine hydrocblorate, 232 
Eucalyptol, 233 
Eucalyptus, 233 
Eudoxine, 234 
Euformol, 237 
Euonymi cortex, 234 
Euonymin, 234 
Euonymus, 234 
Eupatorium, 235 
Euphorbia pilulifera, 235 
Euphthalmin, 235 
Europhen, 236 
Evan's pocket inhaler. 489 
Exalgine, 236 
Exercises for treating locomotor ataxia and 

myelitis, 45S 
Expectorants, 40 45 

sedative, 40, 45 

stimulating, 40^ 45 
Extracts, 26 
Extractum aconiti, 60 



Extractum aloes aquosum, 71 

barbadensis, 71 
arnica? radicis, 94 
belladonnae viride, 109 
cannabis indie®, 137 
cascara? sagrada?, 146 
cirnicifuga?, 178 
cinchona?, 185 
colchici, 199 

radicis, 199 
colocynthidis, 200 

compositum, 200, 390 
conii, 202 
digitalis, 217 
ergota?, 222 
euonymi, 234 

siccum, 234 
gentian 83, 241 
glycyrrhiza?, 291 

purum, 291 
haamatoxyli, 247 
hyoscyami, 258 
jalapa?, 282 
leptandra?, 289 
nucis vomica?, 335 
opii, 342 

physostigmatis, 362 
podophylli, 370 
quassia?, 374 
rhei, 377 
stramonii, 402 

seminis, 402 
strophanthi, 404 
taraxaci, 414 
uva ursi, 425 
Extractum belladonna? alcoholicum, 109 

foliorum alcoholicum, 109 
Extractum aconiti nuidum, 60 
arnica? radicis nuidum, 94 
belladonna? radicis nuidum, 109 
buchu fluiduin, 124 
calumba? fluidum, 130 
cannabis indica? fluidum, 137 
capsici fluidum, 140 
chimaphila? fluidum, 151 
chirata? fluidum, 151 
cimicifuga? fluidum, 178 
cinchona? fluidum, 185 
coca? fluidum, 193 
colchici radicis fluidum, 199 

seminis fluidum, 199 
conii fluidum, 202 
convallana? fluidum, 203 
cubeba? fluidum, 209 
cusso fluidum, 210 
digitalis fluidum, 217 
ergota? fluidum, 222 
eucalypti fluidum, 234 
eupatorii fluidum, 235 
gelsemii fluidum, 240 
gentiana? fluidum, 241 
geranii fluidum, 241 
glycyrrhiza? fluidum, 291 
grindelia? fluidum, 244 
hamamelidis fluidum, 248 
hydrastis fluidum, 253 
hyoscyami fluidum, 258 
ipecacuanha? fluidum, 273 
kola? fluidum, 284 
leptandra? fluidum, 289 
lobelia? fluidum, 293 



800 



INDEX OF DRUGS. 



Extractum lupuliui fluidum, 252 

nucis vomicae fluidum, 335 

pareirae fluidum, 351 

pilocarpi fluidum, 367 

podophylli fluidum, 370 

primi virginianae fluidum, 373 

quassiae fluidum, 374 

rhamui purshianae fluidum, 146 

rhei fluidum, 377 

rhois glabrae fluidum, 377 

rosae fluidum, 378 

sabinae fluidum, 389 

sauguiuariae fluidum, 387 

sarsaparillae fluidum, 389 
compositum, 389 

scillae fluidum, 401 

scoparii fluidum, 392 

senegae fluidum, 392 

seunae fluidum, 393 

serpentariae fluidum, 394 

spigeliae fluidum. 400 

et seunae fluidum, 400 

stillingiae fluidum, 402 

stramonii seminis fluidum, 402 

taraxaci fluidum, 414 

uvae ursi fluidum, 425 

Valerianae fluidum, 425 

veratri viridis fluidum, 428 

zingiberis fluidum, 242 
Extractum belladounae liquidum, 109 

cascarae sagradae liquidum, 146 

cimicifugae liquidum, 17b 

cincbonae liquidum, 185 

cocae liquidum, 193 

ergotae liquidum, 222 

filicis liquidum, 102 

glycyrrhizae liquidum, 291 

hamamelidis liquidum, 248 

hydrastis liquidum, 253 

ipecacuanbae liquidum, 273 

jaborandi liquidum, 367 

nucis vomicae liquidum, 335 

opii liquidum, 343 

pareirae liquidum, 351 

sarsae liquidum, 389 

taraxaci liquidum, 414 

FEEDING THE SICK, 509 
Fel bovinum puriflcatum, 345 
bovis, 345 

puriflcatum, 345 
Ferri et ammonii citras, 277 
sulphas, 275 
tartras, 278 
arsenas, 275 
bromidum, 276 
carbon as saccharatus, 275, 276 
chloridum, 275, 277 
citras, 277 

et potassii tartras, 27rt 
et quininae citras, 278 

solubilis, 278 
et strychninae citras, 278 
iodidum saccbaratum, 279 
lactas, 280 
oxalas, 279 
oxidum bydratuin, 278 

cava magnesia, 100, 278, 294 
phosphas. 280 

solubilis, 280 
pyrophosphas solubilis, 280 



Ferri redactum, 280 

subsulpbas, 275, 279 

sulphas, 275, 280 
exsiccatus, 280 
granulatus, 280 

valerianas, 280, 425 
Ferrum, 274 

dialysatum, 278 

reductum, 275. 280 

tartaratum, 278 
Ferula foetida, 101 
Fevers, cold in, 452 
Filix mass, 101 
Flaxseed, 237 

meal, 237 

oil, 237 

poultice, 237 

tea, 237 
Fleabane, 223 

Fleming's tincture of aconite, 60 
Flexible collodion, 199 
Flowers of sulphur. 4.07 
Fluid extract of cactus grandiflorus, 124 

extracts, 26 
Flying blister, 460 
Food-materials, 511 
Foods for the sick, 509 
Foot-bath, 438 
Formaldehyde, 237> 436 

generator, Novy's, 466 
Formic aldehyde, 237 
Fowler's solution, 98, 99 
Foxglove, 211 
Fumigation, 24 
Fusel oil, 61 

GALLA, 239 
Gallic acid, 238 
ointment, 239 
Gambier, 149 
Garlic, 67 
Gaultheria, 239 
Gavage, 472 

method of employing, 472 
Gelsemii radix, 239 
Gelsemine, 239, 241 
Gelseminic acid, 239 
Gelsemium, 239 

General therapeutical considerations, 17 
Generator, Novy's formaldehyde, 466 
Gentian, 241 
Gentianae radix, 241 
Geranium, 241 
German chamomile, 297 

soft soap, 395 
Germicides, 465 

(Terms, mode of destroying, 465 
Gin, 67 
Ginger, 241 
Glacial acetic acid, 56 
Glandular treatment, 242 
Glauber's salt, 398 
Glonoin, 325 
Glusidum, 379 
Glutei, 238 
Glycerin, 243 
Glycerins, 26 
Glycerinum, 243 

acidi borici, 115, 244 
carbolici, 1 14, 244 
tannici, 244 



INDEX OF DRUGS. 



801 



Glycerinurn aluniiuis, 72, 244 

arnyli, 244 

boracis, 244 

pepsini, 244, 354 

plurnbi subacetatis, 244, 289 

tragacanthse, 244 
Glycerita. 26 

acidi carbolici, 144 
Glycerites, 26 
Glyceritum acidi tannici, 413 

boroglycerini, 115 

bydrastis, 253 
. vitelli, 244 
Glycerole of aloes, 70 
Glycyrrhiza, 290 
Glycyrrhizse radix, 290 
Glycyrrhizinum arnmoniaturn, 291 
Goa powder, 177 
Gold, 244 

bromide of, 121 
Golden seal, 252 
Goodell's pill of tbe tbree valerianates, 426 

sumbul pill, 410 
Goulard's extract, 288 
Graduated medicine glasses, 29 
Granati cortex, 371 
Granatum, 371 
Granulated citrate of magnesium, 295 

sulpbate of iron, 280 
Gray oil, 310 

powder, 310 
Green soap, 395 
Griffith's mixture, 276 

pills, 276 
Grindelia, 244 

robusta, 244 
Gruel, digested, 516 
Guaiac, 245 

resin, 245 

wood, 245 
Guaiaci lignum, 245 

resina, 245 
Guaiacol, 245 

carbonate, 247 
Gum acacia, 51 

arabic, 51 

H^MATOXYLI LIGNUM, 247 
Hsematoxylon, 247 
Hamamelidis cortex, 248 

folia, 248 
Hamamelis, 248 
Heat, 473 

dry, 479 
Heavy magnesium, 294 
Hemlock fruit, 201 

leaves, 201 
Henbane, 257 
Heroin, 248 

Hoffman's anodyne, 249 
Holocaine, 249 

Honiatropinse hydrobromidum, 250 
Homatropine, 250 

hydrobromate, 250 
Home modification of Turkish bath, 476 
Honey, 250 

of borax, 114, 251 

of rose, 251, 378 

of squill, 401 
Hope's camphor mixture, 251 
Hop poultice, 251 
51 



Hops, 251 
Horse-nettle, 399 
Hot-air apparatus, 479 

pack, 477 

springs, 499 
House mixture, 394 
Humulus, 251 
Husband's magnesia, 294 
Huxham's tincture, 185, 394 
Hydragogue cathartics, 46 
Hydrargyri chloridum corrosivum, 305 
mite, 307 

iodidum flavum, 312 
rubrurn, 307 

oleas. 311 

oxidum flavum, 312 
rubrum, 312 

perchloridum, 305 

subchloridum, 307 

subsulphas flavus, 313 
Hydrargyrum, 297 

ammoniatum, 305 

cum creta, 310 
Hydrastine, 252, 253 
Hydrastinine hydrochlorate, 253 
Hydrastis, 252 

rhizoma, 252 
Hydrate of chloral, 151 

of lime, 131 
Hydrated oxide of iron with magnesia, 
100, 278, 294 

sesquioxide of iron, 100, 278 
Hydriodate of scopolamine, 390 
Hydrobromate of homatropine, 250 

of hyoscine, 259 

of hyoscy amine, 258 

of pelletierine, 371 

of quinine, 183 

of scopolamine, 390 
Hydrobromic acid, 121, 253 
Hydrobromide of conine, 202 

of hyoscine, 259 
Hydrochlorate of apomorphine, 94 

of cocaine, 187 

of cotarnine, 205 

of eucaine, 232 

of hydrastinine, 253 

of morphine, 344 

of pilocarpine, 367 

of quinine, 183 

of scopolamine, 390 
Hydrochloric acid, 253 
Hydrochloride of pelletierine, 371 

of phenocoll, 357 

of quinine, 183 

of strychnine, 335 
Hydrocyanic acid, 254 
Hydrogen peroxide, 256, 347 
as an antiseptic, 438 
Hyoscinre hydrobromas, 259 

hydrobromidum, 259 
Hyoscine, 257, 258 

hydrobromate, 259 

hydrobromide, 259 
Hyoscyami folia, 257 
Hyoscyaminse hydrobromas, 258 

sulphas, 258 
Hyoscyamine, 257 
Hyoscyamus, 257 

leaves, 257 
Hypnai, 259 



INDEX OF DRUGS. 



Hypnotics, 40, 46 

Hypodermic injection of apomorphine, 94 

medication, 22, 28 
Hypodermoclysis, 480 

apparatus for, and method of perform- 
ing, 481 
Hypophospkite of calcium, 127, 129 
Hyposulphite of sodium, 398 

TCE-BAG, 445 
1 -coil, 444 

jacket, 444 

poultice, 444 
Ichthyol, 259 
Idiosyncrasy, 27, 36 
Imperial measure, 30 
Incompatibility, 41 
Indian hemp, 134 

poke, 426 
Indications for drugs, 37 
Indirect action of drugs, 21 
Infiltration anaesthesia, 190 

method of producing, 190, 191 
Infusions, 26 
Infusum brayerae, 210 

buchu, 124 

calumbae, 130 

caryophylli, 187 

chiratae, 151 

cinchonas, 185 
acidum, 185 

columbae, 130 

digitalis, 217 

ergotae, 222 

gentianae compositum, 241 

lupuli, 252 

pruni virginianae, 373 

quassias, 374 

rhei, 377 

rosse acidum, 378 

scoparii, 392 

senegae, 392 

sennae, 393 

compositum, 297, 393 

serpentariee, 394 

uvae ursi, 425 
Inhalations, 24, 482 

exercises to be used in, 483, 484 
Inhaler, Allis ether, 228 

chamber, 486 

Denison's resistance, 486 

Esmarch's chloroform, 170 

ethyl chloride, 231 

Evan's pocket, 489 

Yeo's creosote, 206 
Inject io apomorphime hypodermica, 94 

cocainae hypodermica, 193 

ergota? hypodermica, 222 

morphinae hypodermica, 344 
Inspissated ox-gall, 345 
[ntra venous injection, 492 
In unctions, 25 
Iodide of ammonium, 78 

of arsenic. !)9 

of ethyl, 232 

of iron, 27rt 

of lead. 288 

of potassium, 261 

of sodium. 2nd 
of stiont ium, 103 
of thymol, 417 



Iodine, 264 

ointment, 268 
Iodoform, 269 

as an antiseptic, 436 

ointment, 271 
Iodoformum, 269 
Iodol, 271 
Iodothyrine, 420 
Iodum, 264 
Ipecac, 271 
Ipecacuanha, 271 

radix, 271 
Ipecacuanhic acid, 271 
Iron, 274 

by hydrogen, 275 

plaster, 281 
Isopilocarpine, 363 

JABOKANDI FOLIA, 363 
Jaborine, 363 
Jalap, 281 
Jalapa, 281 
Jalapin, 281, 389 
Jamaica dogwood, 368 
Jamestown weed, 402 
James's powder, 86 
Jequirity, 282 
Jervine, 427 

Joint effects of drugs, 34 
Juniper, 282 
Juniperin, 282 
Junket, 520 

KAMALA, 283 
Kaolin, 283 
Kataphoresis, 25, 492 
Kelene, 231 
Kermes mineral, 81 
Kinic acid, 178 
Kino, 283 
Kinovic acid, 178 
Kola, 284 

Kolatannic acid, 284 
Koosin, 210 
Koumvss, 516 
Kousso, 210 
Kreoliu, 208, 437 

LACTATE OF IRON, 280 
of strontium, 403 
Lactophenin, 357 
Lactophosphate of calcium, 129 
Lactose, 405 

Lady Webster dinner pills, 71 
Lamellae atropines, 109 

cocainae, 193 

hoinatrophuc, 250 

physostigmina. 1 , 362 
Lanolin, 284 
Laudanine, 335 
Laudanum, 312 
Laughing gas, 327 
Lavage, 192 
Lavements, 23 
Laxatives, 46 
Lead, 285 

plaster, 289 

-water and laudanum, 288 
Ledoyen's disinfectant solution, 289 

Leeches, 495 

application of, 495, 496 



INDEX OF DRUGS. 



803 



Leeching, 495 

therapeutics of, 495 
Leruou-juice, 186 
Leptandra, 289 
Leptandrine, 290 
Levant worinseed, 387 
Levulose, 290 
Light magnesia, 294 
Lignum vita?, 245 
Lime, 130 . 

-water, 130 
Lingual traction, 227 
Lini farina, 237 
semina, 237 
Liniments, 26 
Linimentum aconiti, 60 
ammonia?, 75 
belladonna?, 109 
calcis, 131 
caniphora?, 133 

ammoniatum, 133 
chloroformi, 176 
crotonis, 209 
hydrargyri, 311 
opii, 343 

plumbi subacetatis, 289 
potassii iodidi cum sapone, 264 
saponis, 133, 395 

mollis, 395 
sinapis, 317 

compositum, 317 
terebinthina?, 424 
aceticum, 424 
Linseed, 237 
oil, 237 
poultice, 237 
Linum, 237 
Lipanin, 290 

Liquor acidi arsenosi, 98, 99 
chromici, 177 
ammonia?, 75 
fortis, 75 
ammonii acetatis, 76 

citratis, 79 
arsenicalis, 98, 99 
arseni et hydrargyri iodidi, 99 
arsenici hydrochloricus, 99 
atropina? sulphatis, 109 
bismuth i et ammonii citratis, 111 
calcis, 130 

chlorinata?, 159 
saccharatus, 131 
caluinba? concentratus, 130 
carbonis detergens, 607 
chirata? concentratus, 151 
epispasticus, 138 
. ferri acetatis, 281 

et ammonii acetatis, 275, 276 
chloridi, 277 
citratis, 277 
perchloridi, 277 

fortis, 277 
persulphatis, 279 
subsulphatis, 279 
tersulphatis, 100 
hamamelidis, 248 
hydrargyri nitratis, 311 
acidus, 311 
perchloridi, 306 
hydrogenii peroxidi, 256 
iodi compositus, 268 



Liquor iodi fortis, 268 

magnesii carbonatis, 294 

citratis, 295 
niorphina? acetatis, 344 
hydrochloride 344 
sulphatis, 344 
tartaratis, 344 
pancreaticus, 349 
pepsini, 354 

plumbi subacetatis, 288 
dilutus, 289 
fortis, 288 
potassa?, 291 
potassii arsenitis, 99 
citratis, 372 
permanganatis, 354 
quassia? concentratus, 374 
rhei concentratus, 377 
sarsa? compositus concentratus, 389 
senna? concentratus, 393 
soda?, 150 
sodii arsenatis, 99 
ethylatis, 397 
silicatis, 394 
strychnina? hydrochloride 335 
thyroidei, 420 
trinitrini, 326 
zinci chloridi, 431 
Liquors, 26 
Liquorice, 290 

root, 290 
Litharge, 289 
Lithia-water, 292 
Lithii benzoas, 292 

bromidum, 121, 292 
carbonas, 291 
citras, 291 

effervescens, 292 
salicylas, 292 
Lithium, 291 
Liver, 242 
Lobelia, 292 
Lobelic acid, 292 
Lobeline, 292 
Lofoten cod-liver oil, 195 
Logwood, 247 
Lotio hydrargyri flava, 313 

nigra, 307 
Lozenges, 27 
Lugol's solution, 268 
Lunar caustic, 319 
Lung expansion, arrangement of bottles 

for promoting, 485 
Lupulin, 251, 252 
Lupuline, 251 
Lupulinic acid, 251 
Lupulinum, 252 
Lupulus, 251 
Lycetol, 293, 368 
Lycopodium, 293 
Lysol, 293 

MAGENDIE'S SOLUTION, 344 
Magnesia, 294 
levis, 294 
ponderosa, 294 
Magnesii carbonas, 294 

ponderosa vel levis, 294 
citras, 295 

effervescens, 295 
sulphas, 295 



804 



INDEX OF DRUGS. 



Magnesii sulphas effervesceus, 296 

Magnesium, 294 

Male fern, 101 

Mainniarv gland, 296 

Mandrake, 370 

Manganese, 296 

Mangani dioxiduni, 296 

sulphas, 296 
Manganum, 296 
Manna, 296 
Marsden paste, 98 
Massa copaibas, 203 

ferri carbonatis, 276 

kydrargyri, 307 
Matricaria, 297 
May apple, 370 
Measures, weights and, 29 
Meconic acid, 335 
Meconine, 335 
Medication by en dermic method, 25 

fumigation, 21 

hypodermic injection, 22 

inhalation, 24 

inunction, 25 

kataphoresis, 25 

mouth, 21 

rectum, 23 
Medicine glasses, graduated, 29 
Mel, 250 

boracis, 114, 251 

depuratum, 251 

despumatum, 251 

rosas, 251, 378 
Mentha piperita, 351 
Menthol, 297. 352 
Mercurial fumigator, 299 

ointment, 310 

oleate. 311, 312 

pills, 307 

plaster, 311 
Mercurol, 297 
Mercury, 297 

biniodide, 307 

ointment, 310 

protiodide, 312 

salicylate, 312 

with chalk, 310 
Metadioxvbenzol, 375 
Methyl acetanilid, 236 

blue, 313 

chloride, 314 

salicvlas, 239 

violet, 313 
Methylene blue, 314 

chloride, 315 

mixture, 175 
Metric equivalents, 31 

system of weights and measures, 30, 31 
Mild chloride of mercury, 307 
Milk, artificial, 520 

of asafcBtida, 101 

of sulphur. 1<)7 

-punch, 66 

peptonized, 513 

-sugar, 405 
Mineral astringents, 44 

cathartics, 46 

springs, 198 
Mint camphor, 352 
Btearopten, 352 

Mistura ammoniaci, 76 



Mistura amygdala, 69 

creosoti, 207 

cretas, 127 

ferri aromatica, 275 
composita, 276 

glycyrrhizas composita, 291 

guaiaci, 245 

olei ricini, 148 

potassii citratis, 372 

rhei et sodas, 377 

sennas composita, 393 

spiritus vini gallici, 67 
Mitigated caustic, 322 
Mixtures, 26 
Modes of action of drugs, 21 

of administering drugs, 21 
Monkshood, 57 
Monobromated camphor, 133 
Monochloral-antipyrin, 259 
Monsel's salt, 274, 279 

solution, 279 
Morphina, 344 
Morphinas acetas, 344 

hydrochloras, 344 

hydrochloridum, 344 

sulphas, 344 

tartras, 344 
Morphine, 335, 344 
Moschus, 316 

Mouth, administration of drugs by the, 21 
Mucilage of acacia, 51 
Mucilago acacia?, 51 
Mulled wine, 66, 520 
Muriate of ammonium, 77 

of morphine, 344 
Musk, 316 
Mustard, 316 

papers, 317 

plaster, 317 
Mydriatics, 41 
Myotics, 41 
Mvristica, 330 
Myrrh, 317 

NAPHTALENE, 318 
Naphthalin, 318 
Naphthaliiiurn, 318 
Naphthol, 318 
Naphtol, 318 
Narceine, 335 
Narcotine, 335 
Nargol, 318, 439 
Nebulizer, Oliver's, 491 

Robertson's, 490 
Nebulizers, 353, 490 
Nervous sedatives, 41, 46 

stimulants, 41, 46 
Neutral mixture, 372 
Nickel, bromide of, 121 
Nitrate of lead, 289 

of mercury, 311 

of pilocarpine, 367 

of potassium, 319 

of silver, 319, 439 
Nitre, 319 
Nitric acid, 323 
Nitrite of amy], 79 

of potassium, 324 

of sodium. 325 
Nitroglycerin, .'>•_'.") 
Nitro-hydroehloiic acid, 254, 326 



INDEX OF DRUGS. 



805 



Nitrous oxide, 327 

Normal saline solution, 505 

Norwood's tincture of veratrum viride, 428 

Nosophen, 329 

Novy's formaldehyde generator, 466 

Nuclein, 329 

Nut-gall, 239, 412 

Nutmeg, 330 

Nutrient enema, 23 

Nux vomica, 330 

OIL OF AMBER, 73 
of garlic, 68 

of rue, 379 

of tar, 369 

of vitriol, 408 
Ointment of aconitine, 60 

of ammoniated mercury, 305 

of antimony, 86 

of atropine ; 109 

of belladonna, 109 

of calomel, 310 

of cantharides, 138 

of capsicum, 140 

of carbolic acid, 144 

of carbonate of lead, 288 

of cbrysarobin, 177 

of cocaine, 193 

of creosote, 207 

of eucalyptus. 234 

of gallic acid, 239 

of galls, 239 

with opium, 239 

of iodide of lead, 288 
of potassium, 264 

of iodine, 268 

of iodoform, 271 

of lead acetate, 288 

of mercury, 310 

of nitrate of mercury, 312 

of oxide of zinc, 346 

of red iodide of mercury, 307 
oxide of mercury, 312 

of resin, 375 

of rose-water, 378 

of salicylic acid, 384 

of stramonium, 402 

of sulphur, 407 

of tannic acid, 413 

of tar, 369 

of tartrate of antimony, 86 

of turpentine, 424 

of veratrine, 426 

of yellow oxide of mercury, 312 
Ointments, 27 
Oleate of aconitine, 59 
Oleatum hydrargyri, 311, 312 

veratrinse, 426 
Oleoresina aspidii, 102 

capsici, 140 

cubebse, 209 

lupulini, 252 

piperis, 351 

zingiberis, 242 
Oleum amygdala, 69 

amygdalae arnarse, 68 
expressum, 69 

cajuputi, 127 

caryophilli, 187 

chenopodii, 150 

cinereum, 310 



Oleum cinnamomi, 186 

copaibse, 203 

crotonis, 209 

cubebae, 210 

erigerontis, 223 

eucalypti, 233 

gaultheria, 239 

jecoris aselli, 194 

juniperi, 283 

lini, 237 

menthse piperita, 352 

morrhuse, 194 

myristicse, 330 

picis liquidse, 369 

pimentse, 68 

phosphoratum, 361 

ricini, 147 

sabinse, 389 

santali, 386 

sinapis volatile, 316 

succini, 73 

tanaceti, 413 

terebinthinse, 422 
rectificatum, 422 

tiglii, 209 

Valerianae, 425 
Oliver's nebulizer, 491 
Opium, 335 

deodoratum, 342 
Opodeldoc, 395 
Orphol, 318 
Orthoform, 345 
Ovarian extract, 345 

juice, 242 
Oxalate of ammonium, 79 

of cerium, 150 

of iron, 279 
Ox-gall, 345 
Oxide of antimony, 81 

of bismuth, 111 

of calcium, 130 

of lead, 289 

of mercury, 312 

of zinc, 346 
Oxygen, 347 

-water, 347 
Oxymel, 251 

scillee, 401 
Oxytocics, 41, 46 
Oysters, peptonized, 514 

PACK, HOT, 477 
Pale cinchona, 178 
rose, 378 
Pancreas, 242 
Pancreatin, 349 
Pancreatinum, 349 
Papain, 350 
Papaverine, 335 
Papayotin, 350 
Papers, 25 
Papoid, 350 
Paraldehyde, 350 
Paraldehydum, 350 
Paregoric, 342 
Pareira, 351 
Pareirse radix, 351 
Parsley, 91 
Pearson's solution, 99 
Pelletierine, 371 
Pepo, 351 



806 



IXJDEX OF DRUGS. 



Pepper, 351 
Peppermint, 351 

-water, 352 
Pepsin, 354 

cordial, 354 
Pepsiuuni, 354 

saccharaturn. 354 
Peptonized beef, 514 
enema, 515 

milk, 513 

-punch, 514 

oysters, 514 
Permanganate of potassium, 354 
Peroxide of hydrogen, 256, 347, 438 
Persulphate of iron, 279 
Petrolatum. 355 

liquidum. 355 

molle, 355 

spissum, 355 
Petroselinum, 91 
Phenacetin, 355 
Phenacetinum, 355 
Phenazone, 86 
Phenazonum, 86 
Phenic acid, 140 
Phenocoll, 357 

hydrochloride, 357 
Phenol, 140 

Phenyl-diniethyl-pyrazolon, 86 
Phenylic alcohol, 140 
Phlebotomy, 507 
Phosphate of ammonium, 79 

of codeine, 194 

of iron, 280 

of sodium, 357 

of strontium, 403 
Phosphide of zinc, 358 
Phosphorated oil, 361 
Phosphoric acid, 358 
Phosphorus, 358 
Physostigma, 361 
Physostigmatis seniina, 361 
Physostigminas salicylas, 362 

* sulphas, 362 
Physostigmine, 361 
Picea, 368 
Picric acid, 362 
Pill of three valerianates, 426 
Pills, 26 
Pilocarpine hydrochloras, 367 

nitras, 367 
Pilocarpine, 363 
Pilocarpus, 363 

Pilula colocynthidis composita, 200 
et hyoscyami, 201 

galbani composita, 101 

hydrargyri, 307 

subchloridi composita. 310 

ipecacuanha- cum scilla, 274 

plumbi cum opio, 288 

quinines sulphatis, 183 

saponin composita. 343 

Bcammonii composita, 390 
Pilula- aloes, 71 

it asafoetidffi, 71 

el f'erri, 71 

et mastiches, 71 

et iiivriliie. 71. 317 
ant iuionii COmpOSitSB, 36 
asafcetidee, 101 
cat hart ica- composite, 200 



Pilula? cathartica? vegetabiles, 200 

ferri, 276 

carbonatis, 276 
iodidi, 279 

opii, 342 

phosphori, 360 

rhei, 377 

composita, 377 
compositus, 377 

scilla? composita, 401 
Pimenta, 68 
Pinkroot, 400 
Piper, 351 

nigrum, 351 
Piperazine, 367 
Piperin, 351 
Piperinum, 351 
Pipsissewa, 150 
Piscidia erTthrina, 368 
Pitch, 368 
Pix, 368 

burgundica, 368 

canadensis, 368 

liquida, 369 
Plaster of ammoniac with mercury, 76 

of arnica, 94 

of asafcetida, 101 

of belladonna, 109 

of Burgundy pitch, 368 

of Canada pitch, 369 

of cantharides, 138 

of capsicum, 140 

of iodide of lead, 288 

of iron, 281 

of lead, 289 

of menthol, 353 

of mercury, 311 

of opium, 343 

of resin, 375 

of soap, 395 
Plasters, 26 
Plumbi acetas, 287 

carbonas, 288 

iodidum, 288 

nitras, 289 

oxidum, 289 
Plumbum, 285 
Plummer's pills, 86 
Podophyllin, 370 
Podophyllum, 370 
Poke-root, 426 
Polygallic acid, 392 
Pomegranate, 371 
Porter, 67 
Port wine, 67 
Potash papers, 319 
Potassa, 149 

caustica, 149 

cum calce, 130, 150, 429 
Potassii acetas, 56 

bicarbonas, 372 

bitartras, 113 

bromidum, 115 

carbonas, 372 

chloras, 156 

citias, 372 

effervescens, 373 

cyanidum, 210 

iodidum, 261 

nitras, :!1!) 

permanganas, 354 



INDEX OF DRUGS. 



807 



Potassii et sodii tartras, 378 

tartras acida, 113 
Potassium acetate, 56 

nitrite, 324 
Precipitated carbonate of calcium, 127 
of zinc, 430 

phosphate of calcium, 127 

sulphur, 407 
Prepared chalk, 129 
Prescription, parts of a, 49 

writing, 47 
. Pride of China, 102 
Protargol, 373, 439 
Protiodide of mercury, 312 
Protonuclein, 330 
Protoxide of nitrogen, 327 
Pruni virginianse cortex, 373 
Primus virginiana, 373 
Prussic acid, 254 
Pseudomorphine, 335 
Pulvis amygdalae compositus, 69 

antimonialis, 81, 86 

aromaticus, 146, 186 

catechu compositus, 149 

cinnamomi compositus, 186 

cretse aromaticus, 129 
cum opio, 129 
compositus, 129 

effervescens compositus, 392 

elaterini compositus, 219 

glycyrrhizse compositus, 291, 393 

ipecacuanhas compositus, 273, 343 
et opii, 273, 343 

jalapse compositus, 282 

kino compositus, 284 

morphinse compositus, 344 

opii, 335, 342 

compositus, 343 

rhei compositus, 377 

scammonii compositus, 390 

sodse tartaratse effervescens, 392 
Pumpkin-seed, 351 
Punch, milk-, 66 
Punk, 61 
Purgatives, 46 
Purging cassia, 146 
Purified aloes, 71 

ox-gall, 345 

sulphide and antimony, 81 
Pyoktanin, 313, 373 
Pyrogallic acid, 374 
Pyrogallol, 374 
Pyrophosphate of iron, 280 

QUASSIA, 374 
Quassias lignum, 374 
Quassin, 374 
Queen's root, 402 
Quercus alba, 375 

Lusitanica, 239 

tinctoria, 375 
Quevenne's iron, 275, 280 
Quicksilver, 297 
Quinicine, 178 
Quinidinse sulphas, 185 
Quinidine, 178 
Quininge bimuriatica carbamas, 184 

bisulphas, 183 

hydrobromas, 183 

hydrochloras, 183 

hydrochloridum acidum, 183 



Quininse sulphas, 183 

valerianas, 183, 425 
Quinine, 178 

chocolates, 184 

tannate, 183 

RASPBERRY, 378 
Rectal medication, 23, 28 
Rectified spirit, 67 
Red cinchona, 178 

iodide of mercury, 307 

oxide of mercury, 312 

precipitate, 312 
ointment, 312 

rose, 378 

wine, 67 
Reduced iron, 280 

Reliability and strength of drugs, 35 
Remedial measures other than drugs, 433 
Remedy, cold as a, 442 
Resin, 375 

cerate, 375 

ointment, 575 

plaster, 289, 375 
Resina, 375 

jalapse, 282 

podophylli, 370 

scammonii, 390 
Resistance inhaler, Denison's, 486 
Resorcin, 375 
Rest cure, 496 

in the treatment of disease, 20 
Restorative beef-essence, 518 
Revulsives, 41 
Rhei radix, 376 
Rheum, 376 
Rhigolene, 376 
Rhubarb, 376 
Rhus aromatica, 377 

glabra, 377 
Rice-water, 518 
Ricinoleic acid, 147 
Robertson's nebulizer, 490 
Roborants, 41 
Rochelle salt, 378, 392 
Rosa centifolia, 378 

gallica, 378 

gallicse petala, 378 
Rose-water, 378 
Rosin, 375 
Rottlera, 283 
Rottlerin, 283 
Rubefacients, 44, 463 
Rubus idseus, 378 
Rue, 379 

Rules for dosage, 27 
Rum, 67 
Russian bath, 477 

SABINA, 389 
Saccharated carbonate of iron, 276 
iodide of iron, 279 
pepsin, 354 
solution of lime, 131 
Saccharin, 379 
Saccharum, 404 
lactis, 405 
purificatum, 404 
Salicin, 379 
Salicinum, 379 
Salicylate of bismuth, 112 



808 



IXDEX OF DBUGS. 



Salicylate of lithium, 292 

of mercury, 312 

of methyl, 239, 384 

of physostigmine, 362 

of sodium, 384 

of strontium, 403 
Salicylic acid, 380 

ointment, 384 
Salol, 385 
Salophen, 386 
Sal prunella, 319 
Salt, 397 
Saltpetre, 319 
Salts, 295 

Sandalwood oil, 386 
Sanguinaria, 387 
Sanguinarine, 387 
Santonica, 387 
Santonin, 387 
Santoninate of sodium, 388 
Santoninic acid, 387 
Santoninum, 387 
Sapo, 394 

durus, 394 

mollis, 395 
Sarsae radix, 388 
Sarsaparilla, 388 
Savine, 389 
Scammonia radix, 389 
Scammonise resinas, 390 
Scammonium, 389 
Scammony, 389 
Schleich's fluid, 190 
Scilla, 400 
Scillin, 400 
Scillipicrin, 400 
Scillitoxin, 400 
Sclerotinic acid, 220 
Scoparii cacumina, 391 
Scoparin, 391 
Scoparius, 391 
Scopolamine, 390 
Seidlitz powder, 392 
Senega, 392 
Senega? radix, 392 
Senegin, 392 
Senna, 392 

Alexandrina, 393 

Indica, 393 
Serpentaria. 394 

rhizoma, 394 
Sherry, 67 

Sick, feeding the, 509 
Silicate of potassium, 394 

of sodium, 394 
Silver nitrate, 319, 439 
Sinapis alba. 316 

alba- semina, 316 

nigra, 316 

nigra- semina, 316 
Sinapisma, 317 
Slaked lime, 131 
Sim i lax. 388 
Smooth sumach. 377 
Snake-weed, 235 
Soup. :;«)i 

liniment, 133, 395 

plaster. 395 
SoCOl line aloes, 69 
Soda. L50 

caustica. L50 



Soda tartarata, 378 
Sodii acetas, 396 

arsenas, 99 

bicarbonas, 396 

boras, 113 

bromidum, 121 

chloridum, 397 

hyposulphis, 398 

iodidum, 264 

nitris, 325 

phosphas, 357 

effervescens, 358 

et potassii tartras, 378 

sal icy las, 384 

santoninas, 388 

sulphas, 398 

effervescens, 398 

sulphocarbolas, 405 
Sodio-theobromine salicvlate, 395 
Sodium, 396 

bicarbonate, 396 

bromide, 121 

cacodylate, 397 

chloride, 397 

ethylate, 397 

hyposulphite, 398 

iodide, 264 

salicylate, 384 

sulphate, 398 

sulpho-carbolate, 399, 405 
Soft petrolatum, 355 
Solanum Carolinense, 399 
Soluble glass, 394 

Solution of acetate of ammonium, 76 
of iron, 279, 281 
of morphine, 344 

of ammonia, 75 

of arsenate of sodium, 99 

of arsenite of potassium, 99 

of arsenous acid, 98, 99 

of carbonate of magnesium, 294 

of chloride of zinc, 431 

of chlorinated lime, 159 

of chromic acid, 177 

of citrate of ammonium, 79 

of bismuth and ammonium, 111 

of iron, 277 

of magnesium, 295 

of potassium, 372 

of hydrochlorate of morphine, 344 

of hydrochloride of morphine, 344 
of strychnine, 335 

of iodide of arsenic and mercury, 99 

of iodine, 268 

of lime, 130 

of nitrate of mercury, 311 

of pepsin, 354 

of perchloride of iron, 277 
of mercury, 306 

of permanganate of potassium, 354 

of potassa, 291 

of soda, 150 

of subacetate of lead. 288 

of sulphate of atropine, 109 
of morphine, 311 

of tartrate of morphine, 344 

of tersulphate of iron, 100 
Somnal, 399 
Sozoiodol, 399 
Spanish fly, 137 
Sparteine sulphas, 391 



INDEX OF DRUGS. 



809 



Sparteine, 391 
Sphacelinic acid, 220 
Spice plaster, 463 
Spigelia, 400 

Spinal anaesthesia, mode of introducing 
the needle in, 192 

extracts, 242 
Spirit of Mindererus, 76 

of nitrous ether, 411 

of turpentine, 422 
Spirits, 26 
Spiritus setheris, 229 

compositus, 249 
nitrosi, 411 

ammonias, 75 

aromaticus, 75 
fcetidus, 75 

cajuputi, 127 

camphorae, 133 

chloroformi, 171, 176 

cinnamomi, 186 

frumenti, 67 

gaultherias, 239 

glonoini, 325 

juniperi, 283 

compositus, 67, 283 

ruenthae piperitae, 352 

myristicae, 330 • 

odoratus, 67 

phosphori, 361 

rectificatus, 67 

vini gallici, 67 
Sponging, cool, 453 
Springs, mineral, 498 
Squill, 400 

Squirting cucumber, 219 
Starch, 401 

glycerite of, 244 

poultice, 401 

-water, 401 
Steam vaporizer, 488 
Stillingia, 402 
Stillingin, 402 
Stomach-pump, 495 
Stout, 66 
Stramonii folia, 402 

semen, 402 
Stramonium, 402 
Strength, relative, of drugs, 35 
Stretcher, bath, 454 
Stronger water of ammonia, 75 
Strontium, 403 

bromide, 403 

iodide, 403 

lactate, 403 

phosphate, 403 

salicylate, 403 
Strophanthi semina, 403 
Strophanthin, 404 
Strophanthus, 403 
Strychninae sulphas, 335 
Strychnine, 330 

hydrochloride, 335 

sulphate, 335 
Styptic collodion, 200, 413 
Stypticin, 205 

Subcarbonate of bismuth, 110 
Subgallate of bismuth, 112 
Sublimed sulphur, 407 
Subnitrate of bismuth, 110 
Subsulphate of iron, 275, 279 



Succinum, 73 

Succus belladonnas, 109 

conii, 202 

hyoscyami, 258 

limonis, 186 

scoparii, 392 

taraxaci, 414 
Sugar, 404 

-beet, 404 

-cane, 404 

of lead, 287 

of milk, 405 
Sulphate of aluminum, 71 

of ammonium, 79 

of atropine, 104, 109 

of calcium, 127. 129 

of cinchonidine, 185 

of cinchonine, 185 

of codeine, 194 

of copper, 204 

of duboisine, 218 

of hyoscyamine, 258 

of iron, 275, 280 

and ammonium, 275 

of magnesium, 295 

of manganese, 296 

of morphine, 344 

of pelletierine, 371 

of physostigmine, 362 

of quinidine, 185 

of quinine, 183 

of sodium, 398 

of sparteine, 391 

of strychnine, 335 

of zinc, 431 
Sulphide of ammonium, 79 

of antimony, 81 

of calcium, 408 
Sulphocarbolate of sodium, 405 

of zinc, 405, 438 
Sulphonal, 405 
Sulphur, 407 

lotum, 407 

ointment, 408 

praecipitatum, 407 

sublimatum, 407 
Sulphurated antimony, 81 

lime, 131 
Sulphuric acid, 408 

ether, 223 
Sumach, smooth, 377 

sweet, 377 
Sumbul, 409 

pill, Goodell's, 410 

radix, 409 
Suppositoria acidi tannici, 413 

asafcetidae, 101 

belladonnas, 109 

glycerinae, 243 

iodoformi, 271 

morphinas, 344 

plumbi composita, 288 
Suppositories, 26 

Suppositorium acidi carbolici, 144 
Suprarenal gland, 410 
Suspension, 503 
Swamp hellebore, 426 
Sweet almonds, 68 

spirit of nitre, 411 

sumach, 317 
Sydenham's laudanum, 342 



810 



INDEX OF DRUGS. 



Syrups, 26 
Syrupus acacia?, 51 
acidi citrici, 186 
allii, 68 
amygdala, 69 
calcii lactopkosphatis, 129 
cascarse aromaticus, 146 
chloral, 155 
codeina?, 194 
ferri broniidi, 276 

iodidi, 278 

phosphatis, 280 

phosphatum cum quiniua et 
strychnina, 280 

quinina? et strychnina? phospha- 
tum, 280 
hypophosphitum, 129 

cum ferro, 280 
ipecacuanha?, 273 
limouis, 186 
picis liquida?, 369 
pruni yirginiana?, 373 
rhei, 377 

aromaticus, 377 
rosa?, 378 
rubi ida?i, 378 

sarsaparilla? compositum, 389 
scilla?, 401 

compositus, 86, 401 
senega?, 392 
senna?, 393 
ziugiberis, 242 

TABELLtE TKINTTEINL 325 
Tables of relative weights and meas- 
ures in the metric and apothe- 
caries' systems, 32 
Tablet triturates, 27 
Tablets, 26 

of nitroglycerin, 325 
Taeniin, 210 
Taka-diastase, 211 
Tamarinds, 412 
Tamarindus, 432 
Tanacetum, 413 
Tannate of pelletierine, 371 

of quinine, 183 
Tannic acid, 412 
Tansy, 413 

tea, 413 
Tar, 369 

ointment, 369 

-water, 369 
Taraxacum, 414 
Tartar emetic, 81, 82 
Tartaric acid, 414 

Tartrate of antimony and potassium, 81, 
82 

of iron and ammonium, 278 
and potassium, 278 

of morphine, 344 

of potassium and sodium, 378 
Tea, beef-, 517 
Terebene, 414 
Terebenum, 414 
Terebinthina, 422 
Terpine hydrate, -115 
Terpini hydras, 115 
T< srpinol, '115 
Testicular juice, 242 
Tetronal. \n 



Thapsia, 415 

Thebaine, 335 

Theine, 124 

Theobromine, 284, 395 

Therapeutical considerations, general, 17 

nihilism, 17 
Therapeutics, definition of, 17 
Thiocol, 416 
Thiol, 416 
Thiolum liquidum, 416 

siccum, 416 
Thiosinamine, 417 
Thiosulphite of sodium, 398 
Thoroughwort, 235 
Thymol, 417 

iodide, 417 
Thymus gland, 418 
Thyreoidine, 420 
Thyroid gland, 418 
Thyroideum siccum, 420 
Tinctura aconiti, 60 

aloes, 71 

et myrrha?, 71, 317 

arnica?, 94 

florum, 94 
radicis, 94 

asafcetida?, 101 

belladonna?, 109 
foliorum, 109 

benzoini, 110 

composita, 110 

bryoniae, 122, 123 

buchu, 124 

caluniba?, 130 

camphora? composita, 133, 342 

cannabis indica?, 137 

cantharidis, 138 

capsici, 140 

cardamomi, 146 
composita, 146 

catechu, 149 

composita, 149 

chiratse, 141 

chloroform i et morphina? composita, 
176, 344 

ciniicifuga?, 178 

cinchona?, 185 

composita, 185, 394 

cinnamomi, 186 

colchici semi n is, 199 

conii, 202 

convallaria?, 203 

cubeba?, 209 

digitalis, 217 

ergota? amnion iata, 222 

ferri chloridi, 277 
perchloridi, 277 

galla?, 239 

gelsemii, 240 

gentiana? composita, 241 

guaiaci, 245 

amnion iata, 245 

hamamelidis, 248 

hamuli, 251 

hydrastis, 253 

hyoscyamij 258 

iodi, 268 

ipecacnanhse <'t opii, 343 

jaborandi, 367 

jalapse, 282 

kino, 283 



INDEX OF DRUGS. 



811 



Tinctura lobelias, 293 
astherea, 293 

lupuli, 252 

nioschi, 316 

rnyrrhas, 317 

nucis vornicas, 335 

opii, 342 

animoniata, 343 
camphorata, 342 
deodorata, 342 

physostigniatis, 362 

podophylli, 370 

pruni virginianas, 373 

quassias, 374 

quininas, 183 

amnion iata, 183 

rhei, 377 

aromatica, 377 
composita, 377 
dulcis, 377 

sanguinarias, 387 

scillas, 401 

senegse, 392 

sennas composita, 393 

serpentarias, 394 

strainonii, 402 

strophauthi, 404 

sumbul, 410 

Valeriana?, 425 

ammoniata, 425 

veratri viridis, 428 

zingiberis, 242 
Tincture of cactus grandiflorus, 124 

of muriate of iron, 277 
Tinctures, 27 
Toast, watered, 520 
Tonics, 41, 46 
Toucbwood, 61 
Transfusion, 504 

abdominal, 507 

apparatus, 506 
Tribrometbane, 122 
Tribrom-pbenol-bismutb, 430 
Trichloracetic acid, 421 
Trikresol, 421 
Trinitrin, 325 
Trinitrophenol, 362 
Trional, 421 
Triturates, 27 
Trituratio elaterini, 219 
Trocbes, 27 

Trocbisci acidi benzoici, 110 
carbolici, 144 
tannici, 413 

bismutbi, 111 

catechu, 149 

cretas, 129 

cubebas, 210 

eucalypti gummi, 234 

ferri redacti, 280 

glycyrrhizas et opii, 291 

guaiaci, 245 

ipecacuanhas, 273 

magnesia?, 294 

mentbse piperita?, 351 

potassii chloratis, 158 

santonini, 388 

sodii santoninatis, 388 

sulpburis, 408 

zingiberis, 242 
Trocbiscus niorphinas, 344 



Trocbiscus morphinas et ipecacuanhas, 278, 

344 
Tropic acid, 250 
Tropin e, 250 
Tullv's powder. 344 
Turkish bath, 474 

home modification of, 476 
Turpentine, 422 

liniment, 424 

ointment, 424 

stupe, 423 
Turpeth mineral, 313 

UNGUENTS, 27 
Unguentum acidi carbolici, 144 

gallici, 239 

salicylici, 384 

tannici, 413 
aconitinas, 60 
antimonii tartarati, 86 
aquas rosas, 378 
atropinae, 109 
belladonnas, 109 
cantbaridis, 138 
capsici, 140 
cetacei, 110 
chrysarobini, 177 
cocainas, 193 
conii, 202 
creasoti, 207 
eucalypti, 234 
gall as, 239 

cum opii, 239 
glycerin i plumbi subacetatis, 244 
ham am el id is, 248 
hydrargyri, 310 

ammoniati, 305 

iodidi rubri, 307 

nitratis, 312 

dilutum, 312 

oleatis, 311 

oxidi flavi, 312 
rubri, 312 

subchloridi, 310 
iodi, 268 
iodoformi, 271 
petrolei, 355 
picis liquidas, 369 
plumbi acetatis, 288 

carbon atis, 288 

iodidi, 288 
potassii iodidi, 264 
resinas, 375 
stramouii, 402 
sulphuris, 408 
terebintbinas, 424 
veratrinas, 426 
zinci oxidi, 346 
Unna's dressing, 346 
Urotropin, 424 
Ursin, 425 
Uva ursi, 424 
Uvas ursi folia, 425 

TTALEKIAN, 425 

V Valerianas rhizoma, 425 
Valerianate of ammonium, 79, 425 

of iron, 280, 425 

of quinine, 183, 425 

of zinc, 425 
Valerianic acid, 425 



812 



INDEX OF DRUGS. 



Val let's mass, 277 

Vapor acidi hydrocyanici, 255 

conii, 202 
Vaporizer, steam, 488 
Vaseline, 355 
Vasomotor depressants, 41, 47 

stimulants, 41, 47 
Vegetable astringents, 44 

cathartics, 46 
Venesection, 507 
Veratrina, 426 
Veratri viridis rhizoma, 426 
Veratrine ointment, 426 
Veratroidine, 427 
Veratrum viride, 426 
Vienna mixture, 175 

paste, 150, 429 
Vinegar, 56 

of ipecac, 274 

of lobelia, 293 

of opium, 342 

of sanguinaria, 387 

of squill, 401 
Vinegars, 25 
Vinum album, 67 

antimoniale, 86 

antimonii, 86 

colchici, 199 
radicis, 199 

seminis, 199 

ergotse, 222 

ferri, 281 

amarum, 281 
citratis, 281 

ipecacuanha?, 273 

opii, 342 

picis, 369 

portense, 67 

quininse, 183 

rub rum, 67 

xericum, 67 
Virginia snake-root, 394 
Volatile oil of mustard, 317 

WAHOO, 234 
Warburg's tincture, 429 
Warming plaster, 138, 368 
Wash, black, 307 

yellow, 313 
Washed sulphur, 407 
Water of cbloroform, 171, 176 
Watered toast, 520 
Waters, 25 
Weights and measures, 29 

tables of relative, 32 

apothecary, 29 

avoirdupois, 30 
Wet caps, 464 

pack, 477, 478 
Whiskey, 67 



White ginger, 241 

lead, 288 

mustard, 316 

oak, 375 

precipitate, 305 
ointment, 305 

wine, 67 
Whytt's tincture, 185 
Wild cherry, 373 
Wine, 67 

of antimony, 86 

of citrate of iron, 281 

of colchicum-root, 199 

of colchicum-seed, 199 

of ergot, 222 

of ipecac, 273 

of iron, 281 
bitter, 281 

measure, 29 

mulled, 520 

of opium, 342 

port, 67 

of quinine, 183 

red, 67 

of tar, 369 

whey, 66, 519 

white, 67 
Wines, 27 
Wintergreen, 239 
Witch-hazel, 248 
Wormseed, American, 150 

XANTHOPUCCIN, 252 
Xeroform, 430 

YELLOW CINCHONA, 178 
gentian, 241 

iodide of mercury, 312 

jasmine, 239 

oxide of mercury, 312 

prussiate of potassium, 204 

pyoktanin, 313 

sulphate of mercury, 313 

wash, 313 
Yeo's creosote inhaler, 206 
Yolk of egg, glycerite of, 244 
Young's rule for dosage, 27 

ZINCI ACETAS, 430 
carbonas, 430 

prsecipitatus, 430 
chloridum, 431, 438 
oxidum, 346 

venale, 346 
phosphidum, 358 
sulphas, 431 
sulpho-carbolas, 405 

as an antiseptic, 438 
valerian as, 425 
Zingiber, 241 



INDEX OF DISEASES AND REMEDIES. 



ABORTION, 521 

Cascara sagrada, or compound liquorice 
powder, as a laxative for associated con- 
stipation ; if these fail, rhubarb or castor 
oil, 521 

Creolin (2 per cent, solution), should be in- 
jected after removal of the membranes, 
or if fever should follow, 523 

Curettement, 523 

Diet and hygiene, 521 

Elaterium, jalap, scammony, strychnine, 
erigeron, cantharides, contraindicated, 
unless very necessary, 521 

Ergot and quinine, in small doses, with 
perfect rest for one or two weeks, and 
antiseptic irrigation as an after-treat- 
ment, 523 

Iodine, applied to the inner surface of 
uterus, after removal of membranes, as 
a hemostatic and antiseptic, 523 

Opium or morphine, best agents to quiet 
uterus if abortion threatens, 522 

Podophyllin, senna, salines in active doses, 
and aloes, not to be used if they can be 
avoided, 521 

Quinine, useful in malarial poisoning, as a 
preventive ; in other cases contraindi- 
cated, 522 

Saline purges contraindicated, except in 
plethoric women, 521 

Sponges should not be used as tampons* 522 

Tampons of absorbent cotton, dusted with 
iodoform, followed later by ergot, if 
abortion is inevitable, 522 

Venesection useful in plethoric women to 
prevent, 522 

Viburnum prunifolium, fluid extract, 
drachm i to 1 (2.0-4.0), taken during 
pregnancy as a prophylactic, 522 

ABSCESS, 523 

Aconite or veratrum viride, in full dose, 
may abort, 523 

Alcohol, given with milk, in cold abscess, 
524 

Belladonna ointment, locally applied to 
abort ; or tincture, internally, if aconite 
is not at hand, 523 

Calx sulphurata, gr. T V (0.006), every hour 
or two, useful to abort or cause absorp- 
tion, 523 

Carbolic acid, minims 5 to 10 (0.3-0 .65) of 
2 per cent, solution, injected into gland 
threatening suppuration, 523 

Cod-liver oil with hypophosphites, quinine, 
and iron, useful in cold abscess, 524 



Hydrogen peroxide, 3 per cent, solution, 
to wash out cavity of tubercular or 
slow abscess, 256, 524 

Incision, if pus forms, followed by irriga- 
tion with carbolic acid (1 : 20) or bichlo- 
ride solution (1 : 5000) and antiseptic 
dressing, 524 

Iodine, locally applied, may abort. 523 

Iodoform gauze, packed into cavity, or 
ethereal solution injected after aspira- 
tion, and antiseptic dressing, useful in 
tubercular abscess, 524 

Lead-water, applied on bread-crumb poul- 
tice or lint, in early stage, to abort, 523 

Nitrate of silver, gr. 20 to 40 (1.3-2.6) to 
the ounce (30.0), locally applied, may 
abort, 523 

Poultices to assist maturation, 524 

Prescriptions for tonics, in cold abscess, 524 

ACIDITY. 

Ammonia, the most active remedy in gas- 
tric acidity, contraindicated if acute 
irritation exists, 75 

Bicarbonate of sodium, in form of efferves- 
cing powder, valuable in gastric acidity, 
397 

Bismuth a slow and feeble antacid, 111 

Carbonate of calcium, precipitated, beet 
antacid in intestinal acidity, 128 

Cerium oxalate, used in some cases of gas- 
tric acidity instead of bismuth, 150 

Charcoal useful in some cases of " sour 
stomach," 145 

Lime-water, 130 

Liquor potassse useful both for gastric and 
urinary acidity, 291 

Magnesium a useful antacid, 294 

ACNE, 525 

Calx sulphurata, gr. ^ to £ (0.006-0.008) 
in pill, thrice daily, in pustular acne, 
131, 525 

Carbolic acid touched to pustules, after in- 
cision, 525 

Cod-liver oil, if scrofulosis exists, 525 

Fowler's solution often cures and prevents 
relapse, dose gtt. 1 to 3 (0.06-0.18), thrice 
daily, for a month or two, 525 

Green or Castile soap used in face-bath 
night and morning, followed by brisk 
rubbing ; if irritation ensues, simple 
cerate or emulsion of bitter almonds 
will relieve, 525 

Ichthyol, 20 to 100 parts of lard, well 
rubbed in, when induration is great, 
260, 525 

813 



814 



INDEX OF DISEASES AND REMEDIES. 



Mercurial ointment, to relieve induration, 
several days intervening between its 
use and that of sulphur, 525 

Phosphorus especially useful in acne indu- I 
rata, 360 

Resorcin, gr. 10 to 20 to the ounce (0.65- 
1.3 : 30.0) of lard, when induration is 
great, 525 

Saline purges, followed by cascara sagrada 
or similar remedy, to regulate bowels, 
if dependent upon obstinate constipa- 
tion, 525 

Sulphur internally and as a wash or oint- 
ment for women with disordered men- 
struation, prescription for, 408, 525 

ADDISON'S DISEASE. 

Suprarenal gland, 410 

ADENITIS, 526 

Ichthyol, prescription for, 526 

Iodine ointment and lard, equal parts, ap- 
plied by inunction night and morning, 
or tincture, as a paint, stopping applica- 
tion on appearance of redness or fluc- 
tuation, 526 

Iron, syrup of the iodide, TT\, 5 to 20 (0.3- 
1.45) in children, 526 

Lancing preferable to allowing abscess to 
break, 526 

Poultice, when redness or fluctuation ap- 
pears, 526 

Eemoval of gland by dissection, if enlarge- 
ment is scrofulous, 526 

Tonics, to improve systemic condition, 526 

ALBUMINURIA. (See Bright's Disease.) 
Gallic acid, if due to atony of kidneys, 238 
Strontium lactate, if due to renal atony, 403 

ALCOHOLISM. (See Poisoning feom 
Alcohol.) 

ALOPECIA, 526 

Chrvsarobin. drachm £ to 1 (2.0-4.0) to lan- 
olin 1 ounce (30.0), 527 

Corrosive sublimate, gr. 2 (0.1) to rectified 
spirit 1 drachm (4.0) and oil of turpen- 
tine 7 drachms (28.0), 527 

Liquor epispasticus painted over bald spot 
after loose hairs have been depilated, 
528 

Pilocarpine, locally applied, often' stimu- 
lates new growth; too much causes 
small pustules around follicles ; pre- 
scription for, 366 

AMBLYOPIA AND AMAUROSIS, 527 
Antipyrin. 528 
Bromide of potassium, 528 
Cauterization of nape of neck. 5:27 
Correction of optical errors, when arising 
from congenital trouble or non-use, 527 
Cups, wet and dry, 527 
Digitalis in toxic case-. 528 
Electricity, constant current, 528 
Emmenagogues, if due to menstrual dis- 
orders, 527 
Fly-blister to temple in Borne eases, 528 
Iodide of potassium, 528 



Lactate of zinc, 528 

Mercury, when due to syphilis, 528 

Metallo-therapy, may be tried in hysteri- 
cal cases, 527 

Nitrate of silver, 528 

Nitrite of amy], inhalations, 528 

Nitro-glycerin, 528 

Nux vomica in ascending doses in tobacco 
or alcoholic cases, 333 

Phosphorus, 528 

Pilocarpine, in ursemic, tobacco, or alcohol 
amaurosis, 365, 528 

Salicylates, 528 

Stretching the optic nerve, 528 

Strychnine, hypodermically, after irrita- 
tion has subsided, 528 

Suspension, and injections of testicular 
juice, 528 

AMENORRHEA, 528 

Aloes, as a specific, when dependent upon 
constipation, atony of sexual system, or 
anemia, 70, 529 

Apiol, 3 to 10 minims (0.15-0.64), in capsule, 
thrice daily for a week before date of 
menstruation, 92, 529 

Arnica, 94 

Binoxide of manganese, gr. 1 to 3 (0.05- 
0.15), taken for two weeks before time 
of menstruation, 296, 529 

Cantharides, as a stimulant, if due to atony 
or depression, 137 

Cimicifuga, fluid extract, ""1 30 (2.0), at 
the proper time for a flow, 178, 529 

Dewees's emmenagogue mixture, 529 

Eupatorium, in hot infusion, if due to cold, 
235 

Goodell's prescription for, 529 

Griffith's pills, largely used when depend- 
ent upon anaemia, 276 

Hot si tz -bath, for several nights before 
period ; mustard added often increases 
its efficacy, 529 

Iron and myrrh, a standard remedy if due 
to atony or anaemia, 317, 529 

Oil of rue, TT\, 5 (0.3), in capsule, thrice 
daily, 529 

Potassium permanganate, useful, but infe- 
rior to binoxide of manganese, 354, 529 

Salines inferior to aloes if due to constipa- 
tion, 529 

Savine, TT^ 5 (0.3), in capsule, thrice daily, 
to stimulate uterus, 289. 529 

Tansy, rr^ 5 (0.3), in capsule, thrice daily, 
of in form of tansy tea, 413, 529 

ANiEMIA, 529 

Aromatic mixture of iron, 275 

Arsenate of iron in anaemia of chronic 
diarrhoea, 275 

Arsenic, not to exceed gr. T \j (0.004) daily, 
alone or combined with iron, valuable, 
533; very valuable in pernicious and 
malarial ameniia, 96 

Arsenite of copper, 205, 533 

Beta-naphthol, when due to intestinal in- 
digestion, 532 

Bitters, simple or aromatic, in conjunction 
w ilh iron, when stomach and intestines 
are. atonic. 532 

Inland's pill, 532. 



INDEX OF DISEASES AND REMEDIES. 



815 



Bromide of iron, gr. 5 to 20 (0.3-1.3), in 
syrup, useful when there is chorea, 276 

Bullock's blood, fresh or dried, given by 
enema when iron fails, 533 

Carbonate of iron, 532 

Chloride of iron, useful because of its tonic 
properties, 277 

Dialyzed iron, 278 

Diet and hygiene, 533 

Hypophosphites and phosphate of lime, 
with cod-liver oil, iron, and quinine, 
when anemia is due to childbearing 
and lactation, 129, 532 

Iodide of iron, syrup of, largely used in 
strumous and scrofulous anseniias, 278 

Iron, 274, 532 

Mercury bichloride or calomel, especially 
valuable in syphilitic cases. Inunctions 
of mercurial ointment, once a day or 
every other day, of service in all forms 
of anaemia, 306, 532 

Oxygen inhalations of value, 347 

Quevenne's iron, 532 

Quinine in malarial cases, and in tonic 
doses in all other anaemias, 532 

Eeduced iron, with laxatives and mineral 
acids for their effects on intestines and 
liver, in uncomplicated cases, 532 

Salol, when due to decomposition-products, 
385 

Sulphate of iron or some other astringent 
preparation in conjunction with mild 
purges, when tongue is broad, flabby, 
and white, 532 

ANAL FISSURE, 533 

Carbolic acid, 1 drop (0.05), applied to fis- 
sure to effect cure ; in addition, when 
hemorrhoids are present, a lotion of 
tannic acid, glycerin, and water, 534 

Castor oil, to relieve bowels if sulphur can- 
not be used, 534 

Flexible collodion, painted over spot, may 
relieve, 534 

Iodoform suppositories, gr. 2 to 10 (0.1- 
0.65), relieve pain of defecation ; bella- 
donna, gr. i (0.015), to be added when 
there is spasm of sphincter, 534 

Potassium bromide, drachms 1| to the 
ounce (6.0 : 30.0) of glycerin, locally ap- 
plied to fissure by means of a brush, 
highly recommended, 534 

Sulphur, gr. 20 to 40 (1.3-2.6), combined 
with powdered cinnamon or aromatic 
powder, at night to render passages soft, 
534 

ANEURISM, 534 

Aconite, inferior to veratrum viride as a 
cardiac sedative, 534 

Chloroform inhalation if dyspnoea is great, 
535 

Digitalis, contraindicated, 534 

Iodide of potassium, in large doses, asso- 
ciated with restricted diet and rest in 
bed; more valuable in syphilitic than 
in other forms of the disease, 262, 534: 

Morphine, gr ^ (0.075), combined with 
chloral or, better, with croton chloral, 
gr. 10 (0.65), in sleeplessness due to pain, 
535 



Veratrum viride, TT\^ 1 to 2 (0.05-0.1), twice 
or thrice daily if beart is excitable and 
vascular tension high, 428, 534 

ANGINA PECTORIS, 535 

Aconite, useful between attacks, 536 

Alcohol, instead of nitrites, when there is 
vascular relaxation, 536 

Antipyrin, gr. 20 (1.3), valuable in some 
cases, 536 

Arsenic, in full dose long continued, and 
elimination of causes of nerve-storm, 
536 

Cactus grandiflorus, in some cases, 124 

Digitalis, when heart is weak, 536 

Ether, in 1-urachm (4.0) doses in ice-water 
or capsule, to nervous females, often 
aborts, 536 , 

Hoffman's anodyne, often the best rem- 
edy, 249, 536 

Morphine, gr. \ to \ (0.016-0.03) hypoder- 
mically, when nitrite of amyl fails to 
relieve, 536 

Nitrite of amyl, inhalation of a few drops 
from handkerchief during attack, 80, 
535 

Nitrite of sodium or potassium, gr. 3 (0.15), 
thrice daily, useless unless arterial ten- 
sion is high and heart throbbing, 324, 
536 

Nitro-glycerin, TTL, 1 (0.05) of a 1 per cent, 
solution during attack, 325, 536 

Phosphorus, gr. r ^ (0.0006), after meals, 
often of value, 536 

Prescription for use between attacks, 536 

Stomach-pump may be required when due 
to overloaded stomach, 536 

Tonics combined with careful diet and hy- 
giene necessary to a cure, 536 

ANOREXIA, 537 

Calomel, useful when following acute dis- 
ease ; nitro-muriatic acid, however, gen- 
erally preferable, 309 

Capsicum, in convalescence, acts most fa- 
vorably, 139 

Chimaphila, in dropsical patients, as ( a 
tonic and diuretic, 151 

Eupatorium useful in, 235 

Gentian, 241 

Prescriptions for tonics, 537 

Quassia, especially valuable when follow- 
ing malarial fever, 374 

APOPLEXY, 537 
Belladonna, hypodermically, if respiration 

fail, 538 
Calomel, gr. \ (0.016) every four hours, if 

symptoms of meningitis arise, 538 
Croton oil, Tl\, 1 (0.05), with sweet oil, IT^ 5 

(0.3), as a depletant cathartic, 537 
Diet, 538 
Elaterium, gr. \ (0.01), as a depletant 

cathartic, 537 
Ice to the head, 537 
Iodide of potassium, in large doses several 

days after attack, when clot has firmly 

formed, to promote absorption, 538 
Massage and electricity, applied to muscles 

to prevent atrophy ; contraindicated if 

inflammation exist, 538 



816 



INDEX OF DISEASES AND REMEDIES. 



Mercury, 538 

Mustard plaster to feet, or mustard foot- 
bath aud ice to head, keeping head high 
and feet low, 537 

Opium aud calomel, gr. \ (0.016) of each 
every four hours, if meningitis arise, 
538 

Stimulants contraindicated, 538 

Strychnine, hypodermically, if respiration 
fail ; is also useful to stimulate trophic 
centres in cord, 538 

Venesectiou, if patient is full-blooded, to 
prevent inflammation and further leak- 
age, 508, 537 

Veratrum viride or aconite, when venesec- 
tion is impossible, to lower blood-press- 
ure, 537 

APPENDICITIS, 538 

Absolute rest necessary, 539 

Ice-bag or leeches, applied to appendicular 
region, 539 

Maguesium sulphate or citrate, 539 

Opium or morphine- (after the bowels have 
moved), to relieve pain and act as an 
antiphlogistic, 539 

Surgical treatment, 539 

ARTHRITIS. 

Bicarbonate of sodium, applied to part on 

lint, to allay pain, 397 
Lithium carbonate and citrate, prevent 

deposit in joints from rheumatoid 

arthritis, 292 
Mustard plaster, as a counter-irritant, 317 
Yeratrine ointment, 426 

ASCARIS LUMBRICOIDES. (See Worms.) 
ASCITES. (See Dropsy.) 

ASPHYXIA, 540 
Ammonia, injected intravenously into leg 

to stimulate heart and respiration, 75 
Artificial respiration, Sylvester's method, 

540 
Electricity, only to be used as a peripheral 

irritant to restore respiration, 543 
Laborde's lingual traction of great value, 

542 
Oxygen inhalations, 347 
Rules regarding position of patient, 541 

ASTHENOPIA, 543 

Cannabis indica, in retinal asthenopia, pre- 
scription for, 136 

Eserine or pilocarpine, weak solution, as a 
stimulant to ciliary muscles, 543 

Glasses, combined with prisms if neces- 
sary, to correct optical defects 543 

Hot compresses, 543 

Massage, rest, salt baths, strychnine, and 
iron, if due to neurasthenia, 543 

Strychnine or tincture of nux vomica in 
large doses, to stimulate ciliary mus- 
cles, 543 

ASTHMA, 544 

Aconite, in early stages, 59 

Arsenic, internally or smoked in cigar- 
ettes, best remedy when mucous mem- 
brane is at fault, 97, 546 



Belladonna, combined with morphine, very 
useful, 107, 544 

Bromide of potassium or sodium, gr. 30 
(2.0), half an hour before retiring, 545 

Bronchitis-tent, 547 

Chloral, rarely useful ; if pushed, danger- 
ous, 154 

Chloroform, inhaled, relaxes spasm ; also 
useful in form of liniment applied to 
chest, to abort, 172, 545 

Cocaine, applied to nasal cavities, if due to 
nasal disorders, 546 

Cofiee, a cup of strong black, during parox- 
ysm, 126, 546 

Compressed and rarefied air, 547 

Diet and hygiene, 546 

Ethyl iodide, to increase secretions and 
prevent thickening, 232 

Euphorbia pilulifera. £ to 1 drachm (2.0- 
4.0) of the fluid extract, 235, 545 

Gelsemium, 240 

Grindelia, fluid extract of, Tu^ 10 to 30 
(0.65-2.0), or leaves soaked in nitre 
smoked as cigarettes, or fumes of burn- 
ing leaves inhaled, exceedingly useful, 
244, 547 

Iodide of potassium, useful in bronchial, 
harmful in gastric,, type. 263, 546 

Lobelia, tincture, TT\, 10 (6.65) every four 
hours, if attack threaten ; in emetic 
dose if heart be strong, when spasm is 
present, 293, 544, 546 

Morphine, hypodermically, gr. \ to \ (0.01- 
0.016), alone or combined with atro- 
pine, 545 

Nitrate of potassium alone or combined 
with belladonna, in form of cigarettes 
or inhalation of fumes, often relieves, 
319, 545 

Nitrite of amyl, 3 to 6 minims (0.15-0.4) 
on handkerchief, inhaled with care, re- 
lieves spasm, 80, 546 

Nitro-glycerin, serviceable if bronchial 
mucous membranes are engorged, 325, 
545 

Oil of amber, 73 

Oxygen inhalations when cyanosis is ex- 
treme, 547 

Physostigma, in bronchial asthma, to aid 
in expelling mucus, 362 

Sandalwood oil, useful in catarrhal cases, 
386 

Tobacco-smoking often efficacious in pa- 
tients not accustomed to it, 546 

Zinc oxide, prescription for, 347 

ATONY. 

Arsenic, in gastric and intestinal atony, 97 

Calumba. valuable in gastro-intestinal 
atonv following fevers, 130 

Capsicum, one of the best remedies in gas- 
tric atony due to debility and alcohol- 
ism, 139 

Cardamom, with bitter tonics and mineral 
acid, in gastro-intestinal atony, 145 

Chimaphila, useful as a stimulating diu- 
retic in atonic renal conditions, 151 

Hydrastis, indicated in atony of mucous 
membranes, 252 

Leptandra, in duodenal atony, 290 



INDEX OF DISEASES AND REMEDIES. 



817 



Pepper, in atony of genito-urinary mucous 

membranes, 351 
Physostigrna, in intestinal and vesical 

atony, 362 
Strychnine, in intestinal atony, 334 

AURAL VERTIGO. 

Pilocarpine, 366 

BALANITIS AND BALANO - POSTHITIS, 

639 

Astringent solutions, to cleanse parts, zinc 
chloride (gr. 4 to the ounce [0.2 : 30.0] ), 
boric acid (1 per cent.), carbolic acid 
(1.5 per cent.) ; silver nitrate (gr. 1 to 
the ounce [0.05:30.0]) especially valu- 
able, 639 

Lead- water, dilute, as a wet dressing, pre- 
ceded by astringent washes, in phimo- 
sis ; if inflammation increases, circum- 
cise, 639 

Silver-nitrate stick, touched to ulcerations, 
639 

Tannin or zinc oxide, as a dusting-powder, 
after retracting prepuce and cleansing 
over absorbent cotton, 639 

BALDNESS. (See Alopecia.) 

BED-SORES, 547 

Aloes, glycerole of, as a local application, 
70 

Alum, with spirit of camphor and white 
of egg, locally applied, to prevent, 547 

Catechu, with lead subacetate, locally ap- 
plied, to harden skin, 547 

Glycerin application daily, after washing 
and rubbing part, to prevent, 243 

Incision, followed by irrigation, if sores 
tend to burrow, 548 

Iron, tincture of chloride, TTL 20 (1.3) every 
four hours, as a tonic, 548 

Nitrate of silver (gr. 20 to the ounce [1.3 : 
30.0]), painted over threatening part, to 
abort. If ulcers form and are sluggish, 
same solution may be used, 322, 547 

Salt and whiskey, rubbed over skin to 
harden it (drachms 2 to the pint [8.0: 
500.0]), 547 

Soap plaster, applied to sore after washing 
with bichloride solution (1:5000) and 
dusting with iodoform, 395, 548 

Supportive measures and increased amount 
of food, if sloughs are large, 548 

Zinc ointment, on squares of lint, some- 
times used in lieu of soap plaster, 548 

BILIOUSNESS, 548 

Aconite, antagonizes the poisonous alka- 
loids which cause slow pulse, high arte- 
rial tension, etc., 551 

Ammonium chloride, gr. 5 (0.3) thrice 
daily, if associated with catarrh, 551 

Bromides and chloral, if nervousness and 
irritation are present, 551 

Calomel, gr. £ (0.01) in powder every fifteen 
minutes until six are taken, followed in 
four hours by a saline, if stools be light, 
309, 550 

Chirata, extract of, gr. 5 (0.35), in hepatic 
torpor, prescription for, 550 

52 



Diet, 550 

Euonymus, extract of, gr. 3 (0.15), 550 

Horseback riding combined with gym- 
nastic movements especially valuable, 
550 

Ipecac, powdered, gr. 30 to 60 (2.0-4.0), or 
apomorphine, gr. ^ (0.004) hypodermic- 
ally, may relieve in first stage, 549 

Leptandra, where liver is torpid, 290 

Mustard plaster or cup to nape of neck, if 
face is flushed ; foot-bath also of service, 
551 

Nitro-muriatic acid, TT^ 3 (0.15), thrice 
daily in water, of great service, 327, 550 

Opium antagonizes the poisonous alkaloid 
which causes hot skin, rapid pulse, di- 
lated pupils, etc., 551 

Podophyllin, gr. £ (0.01), if stools be dark, 
550 

Protiodide of mercury, gr. g$ to 4^ (0.001- 
0.0016), in trituration, thrice daily, if 
due to catarrh, 551 

Salines, if attack is sudden, to sweep out 
poisonous matter, 550 

Salol or salophen, in 10 gr. (0.65) doses, use- 
ful as an intestinal antiseptic, 551 

Stillingia, fluid extract of, dose, 20 drops 
(1.3), 550 

BLEPHARITIS, 551 

Boric-acid lotion when there is accompany- 
ing conjunctivitis, 551 

Chloral, 5 per cent, solution, to remove 
scabs and crusts, 551 

Creolin, 1 to 2 per cent, solution, useful as 
a wash, 208 

Methyl blue, 313 

Ointments, dilute citrine, Pagenstecher's 
(yellow oxide of mercury, 1 gr. [0.05] ), 
vaseline, 1 drachm (4.0), pyrogallic 
acid, milk of sulphur (3 per cent.), lo- 
cally applied after removal of crusts, 
551 

Silver nitrate, touched to crater-like ab- 
scesses, gives good results, 551 

Sodium bicarbonate or biborate solution, gr. 
8 to ounce (0.6: 30.0), to remove scabs 
and crusts, 551 

BOILS, 552 

Belladonna, locally applied to relieve pain 
and inflammation, 552 

Calcium sulphurate hastens pointing and 
prevents formation of new ones ; useless 
in boils of diabetes, 131, 552 

Camphorated alcohol, applied over boils in 
formative stage, then wiped dry, fol- 
lowed by camphorated oil to abort, 133, 
552 

Carbolic acid, 5 per cent, strength, injected 
into apex of boil when formation is as- 
sured, to abort, 144, 552 

Chloride of calcium, added to poultice, 
hastens maturation, 128 

Collodion painted over inflamed spot, to 
abort, 199 ; if pus form, it may be ab- 
sorbed, if not, evacuate by incision, 552 

Egg-shells baked and eaten, for successive 
crops, 131 

Opium, locally applied to relieve pain and 
inflammation, 552 



818 



INDEX OF DISEASES AND REMEDIES. 



Phosphorus, 360 

Poultices, containiug sweet oil and lauda- 
num, to assist maturation, 552 

Prescription for ointment, 552 

Silver nitrate (gr. 20 to the ounce [1.3 : 
30.0]), painted over part, may abort, 
322, 552 

BONE DISEASE. 

Iodide of iron, syrup of, if anaemia exist, 
266 

Iodine ointment, diluted one-half, or tinct- 
ure, locally applied, 266 

BREASTS (INFLAMED). 

Aconite or veratrum viride, to depress cir- 
culation, 553 

Belladonna, internally or as an ointment, 
before and after inflammation,with cold 
compresses to breast, 106, 108, 553 

Breast-pump, if milk continues to form, 
552 

Incise as soon as pus forms, 553 

Pressure bandage with ice-bag, 553 

Purges, mild saline, 553 

BREATH, FETID. 
Camphor, as a mouth-wash, 132 

BROMIDROSIS. 

Belladonna, 106 

Borax of great value, 113 

Carbonate of calcium, precipitated, a useful 

application, 128 
Salicylic acid, used as a dusting-powder, 

prescription for, 383 

BRONCHITIS, 553 

Aconite, alone or combined with sweet 
spirit of nitre, in initial stage, 59, 554 

Amber, oil of, and olive oil (1:3), applied 
to back and front of chest, in infantile 
bronchitis, 73 

Ammoniac, useful in old forms devoid of 
inflammation, 76 

Ammonium carbonate, alone or with the 
chloride, especially useful in children ; 
gr. 2 to 10 (0.1-0.65) in syrup of acacia, 
77 

Ammonium chloride, in second stage, to 
stimulate bronchial tubes, prescription 
for, 556 

Apomorphine, gr. -fa to | (0.006-0.015), as 
an expectorant in subacute stage; if ex- 
udation accumulates rapidly, gr. ^ to 
jo (0.003-0.006), hypodermic'ally, as an 
emetic, 93, 557 

Asafcetida as a stimulating expectorant, 101 

Belladonna, to check excessive secretion 
and stimulate respiration, 556 

Benzoic, acid, 1 10 

Bronchitis tent, 554 

Caffeine, or strong coffee, to stimulate res- 
piration if suffocation threatens, 558 

Camphor, in old or atonic cases, 132; lini- 
ment rubbed on chest, 554 

Cimicifuga in chronic bronchitis, 178 

Codeine, recommended when cough is ex- 
cessive, 194, 554 

Creosote, recommended in chronic bron- 
chitis, 206 



Croton oil and sweet oil (half and half), 
sometimes applied to chest, 209 

Cubebs or copaiba, as expectorants, liable 
to derange stomach, 203, 209, 557 

Digitalis, if heart be feeble, 558 

Dover's powder, gr. 5 to 10 (0.30-0.65), with 
a hot drink, useful in early stage, 553 

Dry cups, if secretion is excessive, 558 

Ethyl iodide, 5 to 10 minims (0.3-0.65), in- 
haled from a handkerchief every few 
hours in the later stages to loosen*secre- 
tions, 232, 557 

Eucalyptus oil, valuable in later stages; 
dose, gtt. 1 to 5 (0.05-0.35), in capsule, 
every three hours, 234, 557 

Euphorbia pilulifera, \ to 1 drachm (2.0-4.0) 
of fluid extract, in chronic bronchitis, 
235 

Flaxseed tea, a useful demulcent, 237 

Gallic acid for profuse expectoration, 238 

Grindelia, very useful in later stages, 244 

Guaiacol vapor inhalations very valuable, 
246 

Hot foot-bath, with drinks of hot lemon- 
ade, in early stages, 553 

Hypnal for cough, 259 

Inhalations of steam from boiling water, 
to relieve bronchial soreness, when 
counter-irritation fails, 488, 489 

Iodide of potassium, often useful when am- 
monium salts fail, contraindicated if 
secretion is excessive, 263 

Iodine externally, 267 

Iodoform, to lessen cough and fetid dis- 
charge, 270 

Ipecac, to unload stomach, 272; as a seda- 
tive expectorant, 273 ; to promote secre- 
tion in first stage, also as an emetic 
when exudation accumulates rapidly 
and suffocation threatens, 554 

Mustard plastei-s, 558 

Myrrh, with expectorant mixtures, useful 
in later stages, 317 

Oro-nasal respirator with terebene, iodide 
of ethyl, and chloroform, 557 

Oxygen inhalations, when dyspnoea is 
great, 347, 558 

Potassium citrate with ipecac, to aid in 
formation of secretion, prescriptions, 
372, 554 

Potassium cyanide for excessive cough, 210 

Pyridine as an inhalant, 556 

Eesin, inhalations of fumes, 375 

Sandalwood oil, in later stages, dose, 5 to 10 
minims, 386, 557 

Sanguinaria, 387 

Senega, a stimulating expectorant in sub- 
acute and chronic stages, 392 

Squill, inferior to other drugs as an expec- 
torant, 400 

Steam inhalations, 487, 488 

Strychnine, to stimulate respiration, if suf- 
focation threatens, 558 

Tar, 369 

Tartar emetic, as an expectorant, gr. n \) 
(0.001) hourly, or 1 drachm (4.0) of solu- 
tion (gr. 2 to the pint [0.1 : 500.0] ), or as 
an emetic in sthenic cases. 85 

Terebene, if ammonium chloride fails; 
dose, 5 to 10 minims (0.3-0.65), in cap- 
sule or emulsion ; must be stopped if 



INDEX OF DISEASES AND REMEDIES. 



819 



kidneys or stomach are irritated ; or 

used in ail inhaler with equal parts of 

iodide of ethyl and chloroform., 414, 

556, 557 
Terpine hydrate or terpinol useful, 415, 557 
Turpentine, inhalations or applied to chest, 

for children diluted one-half with sweet 

oil, 423 
Turpentine stupes, as counter-irritants, 558 
Water, hot and cold dashes, if death is 

imminent from suffocation, 558 

BRONCHOCELE. 

Ointment of biniodide of mercury, useful 

in, 307 
Potassium iodide internally, and tincture 

of iodine externally, 263 
Thymus gland in, 418 

BRONCHORRHOIA. 

Alum, solution, gr. 20 to the ounce (1.3 : 

30.0) ; applied in fine spray, 72 
Gallic acid, 238 

BRUISES. 

Alcohol, as a lotion, very useful, 64 

Arnica, 94 

Liquor plumbi subacetatis, locally applied ; 
strength 1 to 4 ounces to the pint ( 30.0- 
128.0:500.0); contraindicated, if skin 
is broken ; also useful as lead-water and 
laudanum (water 16, lead- water 4, laud- 
anum 1), 288, 341 

Warming plaster, 368 

BUBO. 

Carbolic acid, solution (gr. 8 to the ounce 
[0.6:30.0]), 10-minim injections, pre- 
ceded by ether spray, 144 

Incision, at first sign of suppuration, fol- 
lowed by washing with either bichloride 
solution (1:1000), hydrogen peroxide 
{h strength), or zinc chloride (gr. 40 to 
the ounce [2.5 : 30,0]), 562 

Iodine, painted around spot, with compress 
and spica bandage, or hot bag over 
swelling, 562 

BURNS AND SCALDS, 558 

Anaesthesia, chloroform in, 560 

Antipyrin in solution and ointment, 560 

Bath in the treatment of, 559 

Boric acid solution, a useful dressing, 113, 
559 

Calcium carbonate, precipitated, as a dress- 
ing, 128 

Cantharides, tincture of (1:40), locally 
applied on lint if burn is not diffuse, 
559 

Carbolized sweet oil, cosmoline, or simple 
cerate, useful application to counter- 
irritation burns, 144, 559 

Chloretone, 559 

Cold cream, as a dressing, 378 

Digitalis, in shock, if circulation fails to 
respond to less powerful stimulants, 559 

Glutol, as a dressing, 238 

Hypodermoclysis useful, 481 

Ichthyol ointment, 260 

Lead carbonate, as an ointment, or, with 
linseed or other oils, as a dressing, 2S8 



Lime-water and linseed oil, equal parts, the 
best dressing, 237. Carbolic acid is of 
service, added in proportion of 1 to 20, 
559 

Morphine and atropine, gr. \ to \ (0.016- 
0.03) of former to gr. ^ (0.0006) of 
latter, to allay pain, 558 

Picric acid the best dressing, 363, 559 

Potassium citrate with sweet spirit of nitre, 
if urine is high-colored, 560 

Poultice, applied to counter-irritation blis- 
ter, relieves pain; when blister forms, 
puncture if large, allow to break if 
small, and dress with absorbent cotton, 
464 

Salicylic acid, prescription for, 383 

Sodium carbonate solution often relieves 
pain, 560 

Stimulants, if shock is severe, 559 

Zinc oxide, 346 

CANCER (GASTRIC). 
Arsenic, small doses often repeated, to 

relieve vomiting and pain in gastric 

cancer, 97 
Condurango, in the dose of 1 drachm (4.0) 

of the fluid extract, 201 
Hydrochloric acid, 253 

CANCRUM ORIS. 
Arsenic internally, 97 
Boric acid, as a mouth-wash, 113 

CARBUNCLE. 

Carbolic acid, solution (gr. 8 to the ounce 
[0.6:30.0]), hypodermic injections, to 
abort, 144 

Phosphorus, 360, 

CARIES. 

Lime salts, especially valuable in dental 
caries of nursing women, 129 

CATARRH OF AIR-PASSAGES. (See 

Nasal Catarrh.) 

Alum solution (gr. 20 to the ounce [1.3: 

30.0]), applied in fine spray, 72 
Arsenic, internally, 97 
Camphor, of service in old and atonic cases, 

132 
Sozoiodol, applied locally in 5 per cent. 
solution, 399 

CATARRH OF BLADDER. 

Ammonium benzoate, to render urine acid, 

76 
Juniper, a valuable stimulant in chronic 

cases, 283 

CATARRH OF UTERUS. 

Hydrastis, 252 

Sozoiodol, in powder, applied by tampon, 
in catarrh of cervix uteri, 399 

CEREBRAL DISEASES. 

Blisters, to nape of neck in cerebritis, 461 
Croton oil, in cerebral congestion, 209 
Elaterium. in cerebral congestion. 219 
Phosphorus, often of service in cerebral 
softening, 360 



820 



INDEX OF DISEASES AND REMEDIES. 



Veratrum viride, of greatest value in cere- 
britis during stage of hyperseniia, after 
that period harmful, 428 

CHANCRE. 

Nitric acid, used as a caustic, surrounding 
tissues being protected by oil, 323 

CHANCROID, 560 

Acetanilid, used in a dry powder, 55 

Actual cautery, the most destructive caus- 
tic, 560 

Benzoate of bismuth, 111 

Bismuth and zinc oxide, or calomel and 
bismuth, are substitutes for iodoform, 
561 

Carbolic acid, as a wet dressing (gr. 5 to 
water oz. 1 [0.35 : 30.0]), 562 

Cocaine, 20 per cent, solution, to relieve 
pain of cauterization, 561 

Hot sitz-bath or general warm bath, 562 

Iodoform, the best dusting-powder after 
cauterizing, also useful as a palliative 
treatment, preceded by nitric acid wash 
(3j to water Oj [4.0: 500.0]), in erosive 
chancroid, 561 

Iodol or aristol, as a substitute for iodo- 
form, 561 

Nitric acid, a good caustic, surrounding 
tissues being protected by oil, 323, 561 

Salicylic acid in powder or ointment, 383 

Sulphuric acid with charcoal, a good caus- 
tic and after-dressing, 560 

Tannin, combined with dusting-powder 
(1:4), if discharge is profuse, 561 

CHAPPING. 

Calcium carbonate, precipitated, as a local 
protective in intertrigo of infants, 127 

Camphor, added to precipitated calcium 
carbonate, useful in intertrigo, 133 

Carbonate of zinc, in infantile forms, pre- 
scription for, 430 

Cold cream, a useful application, 378 

Light magnesia, as a dusting-powder in 
intertrigo, 294 

Lycopodium, as a dusting-powder, 293 

Starch, as a dusting-powder in intertrigo, 
401 

Zinc oxide, in powder form, useful in in- 
tertrigo, 346 

CHILBLAINS. 

Alum, as a wash, 72 

Capsicum, tincture, painted over parts or 

applied as a paper, prescription for, 140 
Ceratum resina^, 375 
Ichthyol ointment, 260 
iodine ointment and lard, equal parts, 

give great relief, 267 

CHLOROSIS. (See Anaemia.) 
CHOLERA (ASIATIC), 562 

Camphor, in the form of camphorated wine, 

of the greatesl service; in controlling 

cramps, •"">(;:; 
Enemata of warm salt solution (3j to Oj 

[4.0 to 500.0)), highly recommended 

by Italian observers, 564 



Enteroclysis, associated with hot baths, 
very valuable, 564 

Ether, subcutaneously, as a diffusible stim- 
ulant, 564 

Hypodermoclysis, very useful, 564 

Opium, 563 

Purgatives, contraindicated unless bad 
food has been taken, 563 

Quarantine, and strict hygiene, as pro- 
phylactics, 562 

Salol and salophen, 386, 563 

Sulphuric acid, with camphor, to control 
diarrhoea, 409, 564 

Tannic acid, by enemata (3j-viij to Oj 
[4.0-30.0:500.0]), 564 

CHOLERA INFANTUM, 565 

Arsenic, to check vomiting, prescription 
for, 567 

Beef-juice, as a food, especially valuable, 566 

Brandy, if vomiting is active and collapse 
threatens, a few drops to drachm (4.0) 
of nourishment, 565 

Castor oil, with paregoric, to empty bowels 
and allay irritation, 565 

Cold drinks, cracked ice, and antipyretics, 
if rectal temperature is above normal, 
565 

Diet, 565 

Enteroclysis, very, valuable, 567 

Hot drinks, applications, and baths if rec- 
tal temperature is subnormal, tempera- 
ture being watched, 565 

Iodoform and oil injections to relieve tenes- 
mus, 271 

Irrigation of bowels, 566, 567 

Laudanum, TT^ 10 (0.65), and starch-water, 
oz. 2 (60.0), bv enema, and calomel, gr. 
& (0.005), or gray powder, gr. £ (0.01), by 
mouth, to control vomiting and purg- 
ing, if severe, 567 

MuvStard or spice plaster, over belly, always 
useful, 565, 567 

Podophyllin, if stools are of peculiar pasty- 
white color, 566 

Predigested milk or beef-juice, the best 
food, 565 

Prescriptions for, 567 

CHOLERA MORBUS, 568 

Camphor, 132 

Castor oil, with laudanum, to sweep out 
intestines, before diarrhoea mixture is 
used, 568 

Ipecac, gr. 3 (0.15) every two hours, often 
of service, 273 

Morphine and atropine if pain is severe, 
568 

Mustard or capsicum plaster, over abdo- 
men, 568 

Prescription for, 568 

Salol, prescription for, 385 

chordee, out; 

Aconite, often relieves, 59 

Belladonna internally, and ointment ap- 
plied to under surface of penis, 108 

Bromide of potassium, dr. 1 (4.0), with 
chloral, gr. x (0.6), at bedtime, repented 
during night if necessary, 636 



INDEX OF DISEASES AND REMEDIES. 



821 



Camphor with, bromides, very useful in 
some cases, 132 

Cantharides, tt\, 1 (0.05), thrice daily, 138 

Hot sitz-bath and steeping penis in hot 
water before retiring, relieves, 473 

Lupulin, gr. 30 (2.0), 636 

Morphine, gr. i (0.015), with atropine, gr. 
sV (0.001), hypodermically near peri- 
neum, to relieve, 636 

Opium or belladonna suppositories, to re- 
lieve, 636 

CHOREA, 568 

Arsenic, in ascending doses ; discontinue if 
symptoms of poisoning ensue, 96 

Bromides with chloral, when there is in- 
somnia, prescription for, 569 

Chloral, 154 

Chloroform inhalations when excessive, 
_ 168 

Cimicifuga alone, or with arsenic, very 
useful, 178j 569 

Hot pack, at bedtime, if muscular jerkings 
are severe, 569 

Monobromated camphor, 134 

Nitro-glycerin, 325 

Quinine in full doses, 182 

Salicylates or iodides of value, if associated 
with rheumatism, 569 

Silver nitrate, occasionally used, not re- 
liable, 321 

CINCHONISM. 

Potassium bromide, as a preventive, 119 

CIRRHOSIS OF LIVER. (See Hepatic 
Cirrhosis.) 

COLDS. (See Coryza.) 

COLIC. 

Asafcetida, useful in children, 101 

Chloral and bromide, when severe in chil- 
dren ; prescription for, 154 

Ether internally, very useful, 229 

Hoffmann's anodyne, 229 

Hyoscyamus, 257 

Matricaria, infusion, to prevent, in teeth- 
ing children, 297 

Mustard plaster, \ to \ strength, if skin is 
tender, 317 

Peppermint in infantile colic, 352 

Rue, as a carminative, 379 

COLIC (HEPATIC), 569 

Belladonna, in full dose, to relax spasm, 
107 

Benzoate of sodium, 571 

Calomel, if liver be very torpid, 571 

Chloroform or ether inhalations to relieve 
pain during spasm, 169, 570 

Diet, 571 

Hot applications over liver, as a relaxant, 
569 

Horse-back riding, 571 

Morphine, gr. J to i (0.016-0.03), with atro- 
pine, gr. y^ (0.0006), hypodermically, to 
relieve pain, 569 

Olive or cotton-seed oil, 1} pints (750.0 N >, 
during attack ; ether, drachm 1 (4.0), 
may be added with advantage, 570 



Opium with belladonna, to relieve pain 

and spasm, 339 
Salicylate of sodium, 571 
Turpentine, useful in, 571 

COLIC (RENAL). 

Belladonna, in full dose, 107 

Chloroform, a few inhalations often relieve, 

169 
Opium with belladonna relieves spasm and 

pain, 339 

COLLAPSE. 

Belladonna as a vaso-motor stimulant, 107 
Digitalis, 216 

Ether, by mouth, inhalation, or hypoder- 
mically, of great service, 229 

CONDYLOMATA. 

Calomel, as a dusting-powder, often re- 
moves, 309 

CONGESTION. 

Croton oil, as a revulsive in cerebral con- 
gestion, 209 

Digitalis, relieves stasis of congested lung 
in typhoid state, and congestion of the 
kidneys, 216 

Elaterium, in cerebral congestion, 219 

Ergot of service, especially with digitalis, 
220 

Glycerin, on cotton tampon, as a depletant 
in uterine congestion, 243 

Jalap useful in plethora with cerebral con- 
gestion, 281 

Juniper, often relieves congested kidneys, 
283 

CONJUNCTIVA (BURNS OF), 573 

Atropine incorporated with liquid vaseline 
instilled into eye, to prevent iritis, 573 

Cod-liver oil instilled into eye after re- 
moval of foreign matter, 573 

Gold-beaters' skin inserted between lids 
and eyeball, or breaking up granula- 
tions, prevents corneal inflammation, 
573 

Neutralization of foreign matter, if acid or 
alkaline, 573 

CONJUNCTIVA (CHEMOSIS OF), 576 

Astringent washes, especially alum, 576 
Nicking swollen tissue with scissors, 576 
Warm, moist compresses, 576 

CONJUNCTIVA (HEMORRHAGE BE- 
NEATH), 576 

Boric-acid or cocaine wash, when conjunc- 
tival irritation exists, 576 

Massage of globe through closed lids, to 
aid absorption of blood, 576 

CONJUNCTIVITIS (CHRONIC), 574 

Acetate of zinc, gr. 1 to 2 (0.05-0.1) to the 
ounce (30.0), 430 

Boric acid, wash (gr. 10 to the ounce [0.65: 
30.0]), cocaine, gr. 2 (0.1), may be added 
if there is no corneal ulcer ; for this 
condition salt, gr. 4 to the ounce (0.3 : 
30.0), may be substituted, 574 



822 



IXDEX OF DISEASES AXD REMEDIES. 



Copper crystal, or a solution (gr. 1 to 3 to 
the ounce [0.05-0.15: 30.0]), applied to 
diseased spot, if subacute, 205 

Correction of any refractive error, 574 

Lapis divinus, 574 

Tannin and glycerin (gr. 10 to the ounce 
[0.65 : 30.0J ), as an application, 574 

Yellow oxide or sulphate of mercury salve, 
or alum crystal, useful application, 574 

Zinc oxide, in powder, or the sulphate in 
the form of a wash, 347, 574 

CONJUNCTIVITIS (DIPHTHERITIC), 576 

Atropine instilled, 576 

Boric-acid or bichloride solution, frequent- 
ly applied in early stages, 576 

Cade, oil of, strength 1 : 10, 576 

Citric-acid ointment or lemon-juice, locally 
applied, 576 

Hot compresses, 576 

Quinine, solution (gr. 3 to the ounce [0.15 : 
30.0] ), 576 

Silver nitrate, same as in purulent con- 
junctivitis, 576 

Sulphur, insufflations, 576 

CONJUNCTIVITIS (FOLLICULAR), 575 

Alum, crystal, applied locally if due to 

atropine instillations, 575 
Astringent and antiseptic lotions, 575 
Calomel, as a dusting-powder, alone or 

with bismuth, aristol, or iodoform, 575 
Copper sulphate, as an ointment (gr. £ to 

the drachm [0.03 : 4.0]), 575 

CONJUNCTIVITIS (GRANULAR), 575 
Atropine, instillations, in acute forms, 575 
Boric acid or salicylic acid, solution, as a 

wash in acute forms, 575 
Boroglyceride (20 to 50 per cent.), applied 

to chronic granulations. 575 
Copper sulphate, crystal, applied to chronic 

granulations, 575 
Corrosive sublimate solution (1 : 200 or 1 : 

500), applied every second day in 

chronic forms, preceded by cocaine : 

eyes also being irrigated thrice daily 

with sublimate solution (1 : 7000), 575 
Crushing granulations, often satisfactory, 

575 
Excision of granulations when isolated, 

575 
Glycerole of tannin, applied to chronic 

granulations, 575 
Grattage, 575 
Jequirity infusion (3 per cent.) painted on 

inner side of eyelids, of use, 283, 576 
Leeches to temple, to reduce inflammation 

in acute stage, 575 
Liqnor potassae, beta-naphthol, iodoform. 

aristol in powder or salve, yellow-oxide 

ointment, calomel, or hydrastin may be 

tried. 575 

Scarification, not advisable, 575 

Silver nitrate, stick or solution (gr. 10 to 
the ounce [0.65 : 30.0]), applied daily, if 
there is discharge; neutralize excess 
with salt solution, 322, 575 

Yellow oxide of mercury ointment with 
lard, equal parts, in chronic types, 312 



CONJUNCTIVITIS (LACHRYMAL), 574 

Treatment same as for chronic type. 

CONJUNCTIVITIS (MUCO-PURULENT). 

Treatment same as for purulent type. 

CONJUNCTIVITIS (PURULENT), 573 

Atropine, if corneal ulcer appears, 573 

Bichloride of mercury (1 : 8000), formalde- 
hyde (1 : 3000), or boric acid (saturated 
solution), as a wash, used hourly, 573 

Boroglycerin, 115 

Hot compress, in lieu of cold, if vitality of 
cornea is threatened, 573 

Iced compress in early stage, to reduce in- 
flammation, 573 

Leeching, useful if inflammation is high, 
contraindicated in infants, 573 

Permanganate of potassium, aqua chlorini, 
argentamin, protargol, sulphocarbolic 
acid solution, alum sulphate, zinc sul- 
phate, creolin (1 per cent.), or iodoform 
ointment may be tried, 573 

Silver nitrate, stick or solution (gr. 10 to 
the ounce [0.65:30.0]), touched to lids 
after they have been cleansed of pus, 
excess neutralized with salt solution ; 
2 per cent, solution dropped in newborn 
infant's eves to prevent, 573 

Sozoiodol (2 T30), 399 

CONJUNCTIVITIS (SIMPLE), 572 

Alum crystal applied when it tends to be- 
come chronic, 572 

Atropine usually unnecessary unless cor- 
neal ulcer is present, 572 

Boric acid, lotion (gr. 10 to the ounce 
[0.65 : 30.0]), 572 

Compresses of ice to allav inflammation, 
572 

Creolin solution (1 per cent.), 572 

Mercury, bichloride solution (1 : 10,000), 
if discharge is great, 572 

Peroxide of hydrogen, 572 

Poultices and bandages contraindicated, 
572 

Silver nitrate, solutiou (gr. 2 to 5 to the 
ounce [0.1-0.35 : 30.0] ), if there is muco- 
purulent discharge. If discharge is ex- 
cessive, employ gr. 10 to the ounce (0.65 : 
30.0), and neutralize excess with salt 
solution or wash with tepid water, 572 

Smoked glasses, 572 

Sodium biborate, gr. 4 to 8 to the ounce 
(0.3 to 0.5: 30.0), 572 

Tannin and glycerin (gr. 10 to the ounce 
[0.65: 30.0]), or alum crystal if there is 
a chronic tendency, 572 

Zinc oxide, 347 

Zinc sulphate solution (gr. 1 to 2 to the 
ounce [0.05-0.1:30.0]), alone or with 
boric acid, if there is chronic tendency, 
431, 572 

CONSTIPATION, 576 

Aloes, 70; and podophyllin, with other 
drills, useful for temporary use ; pro- 
scription for, 579 

Belladonna, 108 



INDEX OF DISEASES AND REMEDIES. 



823 



Bryonia, when intestinal secretions are de- 
ficient, 123 
Cascara sagrada, the best curative agent, 
dose, TTL 10 to 40 (0.65-2.65) of fluid ex- 
tract or drachm 1 (4.0) to 6 (24.0) of 
cordial, 146, 579 

Castor oil ultimately harmful in all cases, 
147, 579 

Colocynth, jalap, or senna, not to be used 
constantly, 579 

Compound cathartic pill, sometimes neces- 
sary, 580 

Diet, of extreme importance, 578 

Enemata, as a routine treatment, harmful, 
580 

Glycerin, suppositories or enemata, often 
used, 243, 580 

Gymnastic movements, horseback riding 
or massage, with regulated diet, 577 

Hunyadi, Carlsbad, or Friedrichshall wa- 
ters, rarely of value in chronic forms, 
579 

Leptandra, fluid extract of, in intestinal 
atony, 290 

Lobelia, in combination with cascara sa- 
grada, useful in atonic forms, 293 

Magnesium sulphate by the mouth or by 
enema, 295, 579 

Manna, as a laxative fruit for adults, or 
drachms 1 to 2 (4.0-8.0) to bottle of 
milk, for infants, 296, 579 

Mercury, as an habitual purgative harmful, 
579 

Opium in reflex constipation, 580 

Phosphate of sodium, useful in rickety 
children, gr. 5 to 10 (0.35-0.65) ; or 
adults, 358, 579 

Pilula cathartica vegetabilis, may be re- 
quired, 580 

Ehubarb, usually harmful ; in some cases 
in children, useful, 376, 579 

Salines, simply to unload bowels, 579 

Seidlitz powder, 392 

Senna, said to be useful in constipation 
of pregnancy, particularly if combined 
with cascara sagrada, 392 

Soap suppositories, useful in children, 394 

Stillingia, recommended when habitual ; 
prescriptions for, 402 

Sulphur, especially valuable if hemorrhoids 
are present, 407 

Tobacco, sometimes used, 580 

CONVULSIONS. 

Allium, as a poultice, over spine or feet in 
infantile spinal or cerebral convulsions, 
68 

Amyl nitrite, 80 

Chloral with bromide, in infants; also use- 
ful alone in ursemic and puerperal con- 
vulsions, if no acute renal trouble exists, 
117, 154 

Chloroform, 168 

CORNS, 580 
Fowler's solution, locally applied, 98 
Salicvlic acid, the best application, formula 

for, 382, 580 
Silver nitrate solution (gr. 60 to the ounce 

[4.0:30.0]), applied to soft corns every 

four or five days, 581 



CORYZA, 581 

Aconite, useful in early stages, 60 

Allium, as a poultice to breast, or in emul- 
sion or boiled in milk, for children, 68 

Arsenic, taken for months, often cures per- 
sistent colds, 97 

Antipyrin, in gr. 2 to 4 to the ounce (0.1 to 
1.2:30.0), as a spray, preceded by a co- 
caine spray, 90, 581 

Belladonna in, 108, 582 

Bromides useful in headache, 582 

Camphor, as a snuff, or inhalation of spirit, 
or fumes, when sneezing and lachryma- 
tion are excessive, 133 

Cocaine, a few minims of a 4 percent, solu- 
tion dropped into nostril, followed by 
lotion (see prescription) with atomizer, 
189, 581 

Cubebs, as a snuff during stage of secre- 
tion, 209 

Glycerin, applied alone by brush or spray, 
often of service, 244 

Hamamelis, useful after acute stage is past, 
248 

Hot mustard foot-bath with hot draught or 
Dover's powder, followed by rest in bed, 
may relieve, 582 

Inhalation of tincture of iodine, 268 

Iodide of potassium, at beginning will often 
abort, 263 

Menthol, very useful, 353 581 

Prescription for wash, 581 

Quinine, internally, combined with chlo- 
ride of ammonium, useful after secre- 
tion is established, 582 ; also useful as 
a spray, 183 

Sweet spirit of nitre, 582 

Tartar emetic, 85 

COUGH. 

Acacia, as a mucilaginous drink with flax- 
seed and liquorice, to loosen hacking 
cough, 51 

Almond, essential oil of, in emulsion, as a 
demulcent in cough of phthisis, 68 

Belladonna, the best remedy in nervous 
cough, 107 

Cannabis indica, a useful adjunct to cough 
mixtures, 135 

Chloroform, useful, added to cough mixt- 
ures for irritant cough, 168 

Codeine, useful in nervous cough, 194 

Flaxseed tea, alone or with paregoric, a 
useful demulcent in excessive cough, 
237 

Gelsemium in nervous cough, 240 

Heroin, 248 

Honey, 250 

Hydrocyanic acid, highly recommended, 
prescription for, 255 

Hyoscyamus in nervous cough, 257 

Hypnal, 259 

Iodine, as a paint over supraclavicular 
spaces, in irritative cough, 267 

Ipecac, in spray, useful in chronic winter 
cough, 273 

Morphine in wild-cherry syrup, useful in 
irritative cough and when cough is 
greater than necessary to expel mucus, 
340 



824 



INDEX OF DISEASES AND REMEDIES. 



Paregoric (1 drachm [4.0]) in hot water, 
from which the steam is inhaled, use- 
ful in irritative form of cough, 340 

Sandalwood oil for excessive cough follow- 
ing influenza, 386 

Syrupus pruni Yirginianse, as a vehicle for 
cough mixtures, 373 

CRAMPS. 
Belladonna, internally or locally, as a lini- 
ment. 107, 108 
Chlorodyne. for stomach cramp, 159 
Ginger, especially useful in menstrual 
cramp due to cold, 242. (See Dysmenor- 
rhea.) 

CRETINISM. 

Thyroid gland very useful, 420 

CROUP MEMBRANOUS). (See 
Diphtheria.) 

CROUP SPASMODIC), 582 
Aconite useful, 59 
Amyl nitrite, inhalations, if paroxysm is 

severe, 80, 583 
Antimonial wine, drachm 2 (8.0), to cause 

vomiting if paroxysm is severe, 583 
Belladonna, bromides, chloral, or opium in 

small doses at bedtime, as a preventive, 

552 
Bromides and lactucarium, 552 
Cold cloth around neck, and child placed 

at once in hot bath, air of room being 

moistened by steam, 5S3 
Hot compress is very useful, 473 
Menthol, useful, 457, 583 
Prox>hylactie measures, 582 
Sanguinaria. as an emetic, unfavorable, 387. 

CYSTITIS (ACUTE), 583 

Aconite in full dose, with sweet spirit of 
nitre and potassium citrate if there is 
fever; prescription for. 583 

Belladonna, alone or with aconite, espe- 
ciallv useful if due to cold ; dose, n\ 5 
to 10 (0.3-0.65) thrice daily, 563 

Boric acid, to render urine acid. 114 

Cannabis indica. preferable to opium for 
relieving pain, 136, 584 

Copaiba, 203 

Creolin, as a vesical wash (1 to 2 per cent, 
solution) in cystitis of women, 208 

Flaxseed tea. as a demulcent. 237 

Hot compress over bladder, should not con- 
tain irritants. 583 

Hot siiz-bath and enemata,to relieve bear- 
ing-down pain, 584 

Hygienic measures, 58 1 

Laudanum, rn^ 30 (2.0), to starch-water 
<)/.. 2 (6.0), in enema, to relieve bearing- 
down pain. 583 

Leeches to perineum or cups to Bacrnm, 583 

Opium, belladonna, or iodoform supposi- 
tory, to allay bearing-down pain, 340, 
583 

Quinine, contraindicated, 58 1 

Salines, in early stage to evacuate bowel, 
584 



Salol, gr. 10 (0.65) thrice daily if inflamma- 
tion becomes purulent, 5s4 
TJrotropin in ammoniacal cystitis, 424 

CYSTITIS (CHRONIC), 584 

Arbutin, gr. 3 to 5 (0.25-0.3), or fluid ex- 
tract of buchu or uva ursi, £ to lh 
drachms (2.0-6.0). to improve vesical 
mucous membrane when inflammation 
is of subacute type, 425, 585 

Benzoate of ammonium, urotropin, or boric 
acid, gr. 5 to 10 (0.3-0.65) in pill, to ren- 
der urine alkaline, 76, 584 

Buchu, 123, 555 

Cantharides. 138 

Creolin solution (1 to 2 per cent.), as a vesi- 
cal douche, 585 

Grindelia. as a vesical stimulant, 245 

Juniper of value, 283 

Mercury bichloride solution (1 : 10.000), as 
an injection to cleanse bladder, 584 

Myrrh often of service, 317 

Opium suppositories, gr. k to \ (0.016-0.03), 
very useful, 340 

Pareira, 351 
i Potassium salts, except bitartrate, to ren- 
der urine alkaline when mucus is ex- 
cessive, 584 

Salol, 584 

Sandalwood oil, 386 

Silver nitrate solution (gr. 1 to oz. 4 [0.05 
: 120.0] increased gradually to gr.2 to oz. 
1 [0.1 :30.0]), as an injectiou when dis- 
charge is muco-purulent, followed ba- 
salt solution if pain is severe, 584 

Strychnine and cantharides, when vesical 
atony is great, 585 

Turpentine, oil of sandalwood, cubeb, or 
copaiba, useful when vesical atony is 
great, 555 

Urotropin. 584 

DEBILITY. 
Arsenic, with bitter tonics, very useful, 96 
Calomel, in debility of children, often re- 
lieves, 308 
Capsicum for gastric atony, 139 
Eupatorium, a good tonic, 235 
\ Lime salts, 129 
Phosphorus, of service in sexual debility, 
360 

DELIRIUM TREMENS. 
Chloral, of great service used cautiously, 

154 
Croton oil, 209 
Hops, 251 

Hyoscine, in insomnia. 258 
Monobromated camphor, when nervous 

twitching is troublesome, 134 
Valerian with morphine, frequently used, 

425 

DERMATITIS. 
Chloride of ammonium lotion, when due 

to ivy -poisoning, 78 

DIABETES INSIPIDUS, 585. 

Arsenic. 97 

Belladonna or opium, if due to nervous 
irritability, 585 



INDEX OF DISEASES AXD REMEDIES. 



825 



Carbonate or citrate of lithium, gr. 10 
(0.65), with sodium arsenite, gr. -£$ 
(0.002*, valuable iu gouty types, 292 

Ergot, iu combination with bromide of 
sodium. 222. 585 

Gallic acid, aloue or with opium, one of 
the best remedies, 238. 585 

Opium, 341 

Rhus aromatica, highly recommended, 377 

Strychnine and sulphate of iron, as tonics, 
585 

Suprarenal gland useful in, 585 

DIABETES MELLITUS, 585 

Acidulated water or non-purgative alka- 
line water, to allay thirst, 5S7 

Almond bread, bran bread, or artificial 
milk, as a food for diabetics, 63, 519 

Alum, 72 

Antipyrin, 89, and arsenate of sodium and 
carbonate of lithium when of gouty 
origin, 97 

Carbonate of sodium, by intravenous in- 
jection in diabetic coma, 588 

Chloride of gold and sodium, gr. ^ (0.006), 
recommended. 5S7 

Codeine, in ascending doses, beginning gr. 
1 to 5 (0.05-0.25), thrice daily, 194 

Colchicuniand iodides, in gouty types, 537 

Diet, 5S6 

Ether, hypodermically. to support heart 
in diabetic coma, 533 

Gallic acid, with opium, one of the best 
remedies, 238 

Glycerin or saccharin, as sweetening agents 
to replace sugar, 243. 379, 588 

Iodol, gr. 2 to 6 (0.1-0.3), thrice daily, rec- 
ommended, 271 

Iron, lacto-phosphates of lime and sodium, 
strychnine and astringents, if cachexia 
comes on, 588 

Jambul. gr. 5 to 30 (0.3-2.0), once to thrice 
daily, said to be very useful in some 
cases, 587 

Levulose, 290 

Lime-water, 130 

Lithium carbonate or citrate, with arsenic, 
very useful, if due to gout, 97. 292, 537 

Morphine, very useful in ascending doses, 
587 

Opium, gr. J to i (0.015-0.03), thrice daily, 
largely used, 341, 587 

Pancreatiu, when the disease is due to a 
lesion of the pancreas. 349 

Purgatives, restricted diet, and exercise, 
if due to high living and sedentary 
habits, 5S6 

Salicylates and iodide of potassium, if due 
to rheumatic or gouty taint. 586 

Transfusion, in diabetic coma, 5S8 

DIARRHOEA, 533 

Allspice, 68 

Ammonium chloride, gr. 5 (0.3) every four 
hours, best remedy in persistent catar- 
rhal states, 589 

Arsenic. 97 

Belladonna, mav be used in serous types. 
106 

Beta-naphthol-bismuth, in serous and fer- 
mentative types, 31S 



Bichloride of mercury, gr. o^u (0.0003), 

hourlv, if stools be slimv and bloodv, 

306, 592 
Bismuth, with carbolic acid, gtt. 1 or 2 

(0.05-0.1), highly recommended in se- 
rous and summer diarrhoeas. 111. 591 
Cajuput, n\ 10 to 20 (0.65-1.3), in serous 

forms. 127 
Calomel, followed by a saline, useful in 

sthenic cases of summer diarrhoea, 590 
Calumba, in summer and serous diarrhoeas, 

prescription for, 130 
Camphor, useful in serous but never in 

mucous types. 132, 590 
Carbolic acid, especially useful as an intes- 
tinal antiseptic. 143, 591 
Castor oil, with laudanum and sodium bi- 
carbonate, to unload bowel and render 

it alkaline, 148, 5S9 
Catechu, alone or with opium, in serous 

types, prescription for. 149 
Chalk mixture, with kino and catechu, in 

serous diarrhoeas, prescription for, 123 
Charcoal, useful in acid and fermentative 

types, 145 
Chirata, nitro-muriatic acid, or, better 

still, nitric acid and cardamoms, in 

mucous type, prescription for, 589 
Chlorate of potassium for acute rectal 

catarrh with mucous diarrhoea. 158 
Chlorodvne, largely used in serous types, 

159 
Chloroform, with astringents and opium, 

very useful after removal of irritant 

cause, 171, 590 
Cinnamon, as a stimulant in serous tvpes, 

185 
Cloves, 187 
Copper sulphate, gr. J (0.016) with opium, 

gr. 1 (0.06) in pill, or in enema, gr. 5 to 

20 to the ounce [0.3-1.3: 30.0]), if due 

to ulceration. 204 
Creolin in entero-colitis, 5 : 1000 of water, 

208 
Diet, for summer diarrhoea, 589 
Enteroclysis, when mucous form becomes 

chronic, 589 
Ergot, sometimes useful in serous types, 

222 
Eudoxine, 234. 591 
Gallic acid, 238 
Geranium. 1 to 2 roots, boiled in pint of 

milk, of great service in infantile tvpes. 

241 
Ginger, a good addition to diarrhoea mixt- 
ures, 242 
Guaiacol carbonate, in fermentative forms 

of, 247 
Efeinatoxylon, useful in children, because 

of agreeable taste, 247 
Hope's camphor mixture, in serous and 

choleraic tvpes, 251 
Ipecac, gr. 4, to \ (0.015-0.03) thrice daily, 

useful in summer diarrhoea of children. 

273, 591 
Kino, formula for, 283, 590 
Lead acetate, with opium and camphor in 

serous types, prescription for. 287. 589 
Mercurv. with chalk or calomel, in hepatic 

disorder. 310, 590 
Morphine, gr. fo to ^ (0.0008-0.0012) hypo- 



826 



INDEX OF DISEASES AND REMEDIES. 



derniically, often checks summer diar- 
rhoea in children, 341 

Mustard plaster, or other counter-irritants, 
to abdomen, 589 

Naphthalin or naphthol, in fetid and sum- 
mer diarrhoeas, 318, 591 

Nitrate of silver and hyoscyarnus, or lead 
acetate and opium, in mucous diarrhoea, 
prescription for, 589 

Xitro-muriatic acid, or podophvllin, gr. 
h to ? V (0.0012-0.0016), in" summer 
diarrhoea, if duodenum is at fault, 327, 
591 

Xutmeg, useful in serous types, 330 

Opium, 341, 590 

Pancreatin in lienteric diarrhoea, 349 

Pepsin with hydrochloric acid in summer 
diarrhoea, if gastric digestion is defi- 
cient, 591 

Phosphate of sodium, lime salts, and com- 
mon salt in summer types, if rickets is 
present, 358, 591 

Podophyllin, 370, 591 

Potassium iodide, gr. 3 to 5 (0.15-0.3), if 
catarrhal state is obstinate, 589 

Precipitated carbonate of calcium, in 
serous diarrhoea, 128 

Easpberry-leaves, used in domestic medi- 
cine, 378 

Ehubarb, often useful, preceding direct 
treatment in summer diarrhoea, 376 

Salol combined with chalk mixture, 385, 
591 

Sulphate of iron in chronic forms, 280 

Sulphocarbolate of zinc, 2 grains (0.1) 
every three hours ; of service in summer 
diarrhoea, 591 

Sulphocarbolates, 405 

Sulphuric acid, especially valuable in 
serous types, prescription for, 409, 590 

Tannic acid, in atonic or serous types, 413 

Tar mixture, highly recommeuded in ob- 
stinate types, formula for, 369 

Thymol, naphthalin, and especially sali- 
cylic acid, useful as intestinal antisep- 
tics, in summer diarrhoea, 591 

Zinc oxide, in summer types, prescription 
for, 347 

Zinc sulphate, 2-grain (0.1) pills, especially 
useful with opium, or podophyllin, gr. 
-fo (0.001), in serous types, 431 

DIARRH(EA (CHRONIC), 593 

Arsenic, 97 

Bismnthi et ammonii citras, in chronic 

serous tvpes, 111 
Diet. 593 
Iron sulphate, gr. 5 (0.3) in pill, in chronic 

types, 280 
Nit lie acid, with a bitter tonic, useful in 

green diarrhoea of children, combined 

with pepsin, 324 
operative procedures when due to lesions 

of the rectum, 593 
Rockbridge alum water, useful when 

anemia is present. 593 
Silver nit rate in pill form, or in other eases 

rectal injections of this drug, gr. 2 to 

<>■/.. 1 (0.1:30.0), followed by iodoform 

Suppository, of greatest benefit, 593 



Sodium bicarbonate, gr. 5 to 20 (0.3-1.3), 
and iodoform suppositories, by their 
combined action, give great relief, 593 

DILATATION (GASTRIC AND INTES- 
TINAL). 
Physostigma with nux vomica, 362 

DIPHTHERIA, 594 

Aconite, in early stages, 59 

Alum, 72 

Antistreptococcic serum, 440 

Antitoxin, of great value ; 5 to 10 cubic 
centimetres should be thrown into the 
connective tissues of the back. A spe- 
cial syringe is used for this purpose, 
and should be perfectly aseptic, 440, 
594 

Calomel by sublimation, of great good in 
some cases, 597 

Carbolic acid (1 : 100) in the form of spray 
or gargle, 143 

Chlorate of potassium, contraindicated for 
internal use, because of danger to the 
kidneys. It may be applied upon a 
swab, 157, 598 

Corrosive sublimate, gr. ■£$ (0.0012), or calo- 
mel, gr. £ to I (0.01-0.015) every hour, 
unless diarrhoea or ptyalism be pro- 
duced, 306, 597 

Ice-bags to the neck, ice in the mouth and 
the tincture of the chloride of iron in- 
ternally, if glandular suppuration 
threatens, 598 

Irrigation of the nasal chambers useful in, 
597 

Lime-water as spray or application very 
useful in, 131 

Loeffler's application (menthol, dr. 2\ [10.0], 
dissolved in dr. 9 [36.0] of toluol ; add 
dr. 1 [4.0] of liquor ferri chloridi and 
absolute alcohol, fl. oz. 2 [60.0]), 596 

Milk diet, 597 

Monsel's solution, as a topical application, 
279 

Oxygen inhalations, strychnine, and atro- 
pine if suffocation is imminent. Intu- 
bation or tracheotomy may be neces- 
sary, 597 

Peroxide of hydrogen is the best local ap- 
plication. May be applied on a swab or 
as a spray (1 :4), to remove false mem- 
brane, 256, 594 

Potassium permanganate, solution (gr. 20 
to the pint [1.3: 500.0]). applied as a 
swab or gargle, 355 

Salt solution (7: 1000), as a spray in nasal 
diphtheria, 594 

Tincture of the chloride of iron, 277 

Tonics, such as quinine, strychnine, and 
the chloride of iron, as supportive meas- 
ures, 597 

Turpentine, by inhalation, prescription for, 

597 

DROPSY, 598 

Acupuncture, less favorable than incisions, 
only to be resorted to after other reme- 
dies fail, 133, 602 



INDEX OF DISEASES AND REMEDIES. 



827 



Apocynum, in cardiac or renal dropsy of 

the subacute or chronic type, 92 
Caffeine, in cardiac or renal dropsy, 126 ; in 

torpidity of kidneys, 601 
Calomel and digitalis, in renal and cardiac 

types, 303, 601 
Colocvnth, compound extract of, gr. 2 to 6 

(0.1-0.3), 200, 600 
Copaiba, of service in slow renal types, 203 
Digitalis. TT^ 5 to 10 (0.35-0.65), with can- 

tharides, Ttl 1 (0.05), thrice daily, in 

renal torpidity due to heart trouble, 601 
Elaterium, especially useful in renal dropsy, 

219, 600 
Jalap, compound powder of, gr. 20 to 30 

(1.3-2.0), with potassium bitartrate, gr. 

10 (0.65), added, especially serviceable in 

renal dropsy, 281, 600 
Magnesium sulphate, in concentrated solu- 
tion, before breakfast, 295, 601 
Milk diet, very useful, 601 
Paracentesis abdominis, very useful in 

ascites, 601 
Pilocarpine, useful in localized and renal 

dropsy, contraindicatedin cardiac tvpes, 

365, 601 
Potassium iodide, in hepatic cirrhosis and 

localized effusions, to remove liquid, 602 
Scoparius, infusion, may be used, 392 
Senega, rarely of value, 392 
Squill with digitalis, prescription for, 400, 

601 
Strophanthus in cardiac dropsy, 404 
Sugar of milk, useful as a diuretic, 405, 601 
Tapping in ascites, the best method, 601 

DYSENTERY, 591 

Alum, internally, 72 

Arsenic, 97 

Bichloride of mercury, gr. ^h (0.0003), if 
passages are slimy and bloody, 592 

Bichloride of mercury, injections (1 : 5000), 
followed by solution ( 1 : 30,000) to pre- 
vent toxic effect by absorption, 592 

Boric acid, 3j to Oj (4.0:500.0), or sul- 
phocarbolate of zinc, gr. 15 to 1 quart 
(1.0 : 1000.0), very useful as rectal injec- 
tion, 592 

Calomel, in purgative dose, contraindicated 
if weakness exists, 30S, 592 

Continuous irrigation with two-way tube, 
of great value, 592 

Copaiba, 203 

Creolin enemata, 208 

Ergot, useful in bloody stools, 222 

Hamamelis, injections, if much blood is 
present, 592 

Ice-water, injections, if due to inflamma- 
tion, used only in strong persons, 592 

Ipecac, best remedv in acute dvsentery, 
273, 592 

Lead acetate, with opium and camphor, 
prescription for, 288 

Mtro-hydrochloric acid, if due to defective 
action of secretory glands, 327, 592 

Prescription for enema, 592 

Quinine injections useful in amoebic dysen- 
tery, 183, 592 

Silver nitrate, rectal injections (gr. 10 to 20 
to the pint [0.6-1.3 : 500.0]), if ulcers are 



chronic ; followed by salt solution if 

action is too severe, 321, 592 
Sulphate of magnesium, 592 
Tannic acid (3j [4.0] to water Oj [500.0]), 

in the form of intestinal irrigation, 592 

DYSMENORRHEA, 602 

Amyl nitrite, often relieves, 80 

Antipyrin or acetanilid, in neuralgic at- 
tacks ; in other cases of doubtful value, 
89, 603 

Belladonna, suppository, gr. § (0.03), of ex- 
tract or ointment applied to os ; tinc- 
ture, internally, useful to relax spasm, 
108, 602 

Camphor with acetanilid, in pill, useful in 
nervous cases, 132 

Cannabis indica and gelsemium, often of 
service, 136, 603 

Cimicifuga in neuralgic form, 603 

Epsom salts or aloes, if constipation is 
present, 602 

Ether or bromide of ethyl, 603 

Gelsemium in spasmodic forms, 240 

Hotsitz-bath, followed by turpentine stupe, 
and Dover's powder, gr. 10 (0.65), often 
relieves, 474, 602 

Iron, strychnine, and quinine, as tonics, 
with rest and horseback riding for anae- 
mic and run-down patients, 603 

Opium, to relieve spasm and pain, 339, 602 

Piscidia erythrina, extract, in the dose of 
from | to 2 fluidrachms (2.0-8.0), 368 

Potassium bromide, 118 

Water, cold and hot, alternately dashed 
over loins in atonic 



DYSPEPSIA. (See Indigestion.) 

Arsenic, useful in atonic types associated 
with chronic diarrhoea, 97 

Benzo-naphthol, in fermentative dvspepsia, 
318 

Bismuth, when due to acid fermentation, 
111 

Bismuth subgallate in fermentative dys- 
pepsia, 112 

Gentian, 241 

Hydrastis, as an antiseptic and curative 
agent in chronic types, 252 

Hydrochloric acid, if gastric secretion is 
deficient, 253 

Lavage in fermentative dyspepsia, 492, 671 

Xitric acid with bitter tonics often relieves 
. intestinal types, 324 

Permanganate of potassium, 354 

Quassia, useful, if not due to gastritis, 374 

Serpentaria, as a tonic in atonic types, 394 

Strontium bromide, in painful dvspepsia, 
403 

Terebene, useful as an antiseptic in fer- 
mentative dyspepsia. 414 

DYSPNOZA, 603 

Ammonium carbonate, as a respiratory and 
cardiac stimulant, 604 

Arsenic, continuously employed, useful in 
emphysema and chronic pulmonary in- 
flammation, 604 

Dry cupping over back, when due to car- 
diac or pulmonary trouble, 604 



828 



INDEX OF DISEASES AND MEMEDIES. 



Hyoscine, contraindicated, 604 

Morphine, gr. £ to i (0.008-0.016), night and 
morning, often cures when due to ner- 
vous or cardiac disorders, 342, 604 

Opium, if due to nervous disorders, 604 

Strychnine, in idiopathic types and when 
due to hrouchorrhcea in old people, 344, 
604 

Thoracentesis if there is pleural effusion, 
604 

EAR (DISEASES OF). 

Bismuth subgallate, useful in purulent 
otitis media, 112 

Glycerin, useful to soften impacted ceru- 
men, 243 

Potassium permanganate, solution, useful 
in purulent otitis media, 355 

EARACHE, 604 

Cardiac sedatives, 605 

Chloroform, on swab, behind and in front 
of ear in otalgia, 606 

Cocaine, TT^ 1 to 3 (0.5-0.15), or adrenalin 
chloride (1 : 5000 solution), dropped into 
nostril, followed by spray if mucous 
membrane is engorged, 605 

Heat, dry, applied to head on affected side, 
604 

Inflation of Eustachian tube with Politzer's 
air-bag, 605 

Irrigation with normal salt solution hot as 
can be borne, gives great relief, 605 

Leeching behind ear, to relieve pain, 604 

Menthol and albolene spray, following co- 
caine, 605 

Poultices, oil, and laudanum, contraindi- 
cated, 604 

Puncture of tympanum, if it bulge, fol- 
lowed by careful cleansing and insuffla- 
tion of boric acid, 605 

Tincture of belladonna and of opium 
dropped into the ear, 605 

ECLAMPSIA, 730 

Amyl nitrite, dangerous, 80 

Chloral and bromide, each 1 drachm (4.0), 

by rectum, before applying hot pack, 731 
Chloroform, pushed rapidly as possible, at 

onset of attack, 731 
Elaterium, gr. i (0.016), rubbed up with 

butter, or compound jalap powder and 

calomel, mav be substituted for croton 

oil, 731 
Ether, as an anaesthetic, contraindicated, 

731 
Extraction of child rapidly as possible, if 

attack comes on during labor, 731 
Ice-bag to head while in warm pack, 731 
Morphine, veratrum viride, and amyl ni- 
trite, may be held in reserve, to be used 

if necessary, 731 
Pilocarpine, contraindicated, 731 
Venesection, hot wet pack, and croton oil, 

TT^ 2 (0.1), with sweet oil on tongue, to 

eliminate poison, 730 
Veratrum viride in full doses, 428, 731 

ECZEMA, 606 
Ammoniatod mercury in chronic dry form, 
305 



Arsenic, only when skin is very dry, 97 
Bismuth subgallate in weeping eczema, 112 
Black wash of value in, 307, 606 
Calamine in moist eczema, 430 
Cantharis, internally in small doses, 138 
Carbolic-acid ointment (minims 10 [0.65] to 
cerate 1 ounce [30.0]), to prevent itch- 
ing, 143 
Dermatol in weeping eczema, 112 
Green soap, 395, 607 
Hygienic measures and diet, 606 
Ichthyol ointment, highly recommended, 

260 
Internal treatment, 608 
Iron, syrup of iodide, in young children 

with anaemia and debility, 278 
Kaolin as a dusting-powder, 283 
Lead, dilute solution of subacetate, a useful 

lotion, 289 
Liquor carbonis detergens, in acute cases, 

607 
McCall Anderson's ointment, 606 
Methyl blue in eczema of the eyelids, 313 
Ointments, prescriptions for, 346, 606 
Poultices, or olive oil with carbolic acid 
(TIL 1 to 2 to the ounce [0.05-0.1 : 30.0]), 
followed by soap and water, necessary 
in some cases to soften scales, before use 
of ointment, 607 
Prescription of iodol, as an ointment, about 

nose and lip, 271 
Eesorcin ointment (gr. 2 to 30 to the ounce 
[0.1-2.0:30.0]), locally applied in sub- 
acute types ; in chronic form ointment 
(gr. 2 to 10 to the ounce [0.1-0.65 : 30.0]), 
375, 607 ; solution, gr. x to xv (0.6-1.0) to 
f ^j (30.0), in itching of erythematous 
form, 376, 607 
Salicylic acid ointment (gr. 30 to 60 [2.0- 
4.0] to lard 1 ounce [30.0]), in chronic or 
weeping types, 383, 607 
Starch poultice, in crusty eczema, 401 
Tar ointment, in chronic forms, 369, 607 
Thiol, as a dusting-powder, preceded by an 
antiseptic wash, especially suited to 
moist eczema, 416 
Unna's dressing, 346 
Zinc carbonate, as a protective powder in 

weeping eczema, 430 
Zinc oxide, as a dusting-powder or oint- 
ment in early stages, applied directly 
or on lint, generally preceded by black 
wash, 346, 606 

EMISSIONS, 608 
Bromide of sodium or potassium, gr. 20 

(1.3), at bedtime, valuable in spinal 

irritability, 117, 608 
Chloral, gr. 20 (1.3), at bedtime, 608 
Cold sponging of perineum and scrotum, 608 
Hygienic measures, 608 
Hyoscine, gr. T fo (0.0006), of great value, 

259, 608 
Monobromated camphor very useful in 

spermatorrhoea, 134 
Potassium citrate, gr. 20 (1.3), thrice daily. 

to render urine non-irritating, 608 
Strychnine and arsenic, in full dose, of 

great service in genital atony, 609 
Warm bath before retiring, often useful. 

608 



INDEX OF DISEASES AND REMEDIES. 



829 



EMPHYSEMA OF LUNGS. 
Cod-liver oil, useful, 196 . 
Ethyl iodide, 232 
Euphorbia pilulifera, £ to 1 drachm (2.0- 

4.0) of the fluid extract, 235 
Iodide of potassium, 263 
Physostigma, aids in expelling mucus, 262 
Strychnine, 334 

EMPYEMA. 

Iodine, gr. 6 (0.4) ; potassium iodide, gr. 6 
(0.4) ; water, 1 pint (500.0), as an irri- 
gating fluid, used daily, 267 

ENDOCARDITIS, 609 

Aconite, tincture of, Tr\, 2 to 3 (0.1-0.15), 

hourly, in early stages of acute sthenic 

types, 609 
Antirheumatics, antilithics, or iodides, if 

due to diathetic taint, 609 
Antistreptococcic serum in ulcerative endo- 
carditis, 442 
Calomel, gr. i (0.015), with morphine, gr. 

-£g (0.006), every two hours, in early 

stages, 304, 609 
Digitalis, to strengthen heart in later 

stages, 610 
Ice-bag over prsecordium, 609 
Iron, tincture of chloride, associated with 

supportive treatment, in purulent types, 

610 
Leeches or wet cups, in early stages, to 

abort, 609 
Mercury, in full dose, sthenic cases, 304 
Veratrum viride, used for same purposes 

as aconite, 609 

ENTERITIS. (See Dysentery and Diar- 

EHCEA.) 

EPIDIDYMITIS, 640 

Guaiacol used locally highly recommended, 

247 
Heat, moisture, and pressure, in later 

stages, to relieve induration, 641 
Horand-Langlebert's dressing, 641 

IC6-t)£L2fS 640 

Iodide o'f potassium, gr. 10 to 20 (0.65-1.3), 
thrice daily, to remove induration, 641 

Iodine, painted over scrotum, said to be 
beneficial, 641 

Mercury and belladonna ointments, equal 
parts, or iodine, gr. 4 (0.25), with lano- 
lin, ounce 1 (30.0), locally applied, to 
relieve induration, 641 

Punctures, useful to relieve tension and 
alleviate pain, 640 

Best in bed, elevation of pelvis and testi- 
cles, cessation of local gonorrhoeal treat- 
ment, and administering treatment for 
acute inflammation, 639 

Silver nitrate, solution, painted over scro- 
tum, in early stage, may relieve, 321, 
463, 640 

Strapping and suspending testicle, to re- 
duce inflammation, 640 

EPILEPSY, 610 

Acetanilid, 54, 617 

Adonis vernalis with bromides have been 
found useful, 61, 614 



Ammonium or sodium nitrite, used to sup- 
plement amyl nitrite, 616 

Amyl nitrite, inhalations, when aura is 
perceived and also in status epilepticus 
to relax spasm, 80, 615, 616 

Anaesthetics contraindicated in all cases 
except status epilepticus, when chloro- 
form may be used to control attack, 
616 

Antifebrin and antipyrin especially useful 
in some cases, 89, 617 

Belladonna, with bromides, recommended, 
614 

Bleeding for the status epilepticus, 616 

Borax may be used, 113, 617 

Bromate of potassium, 613 

Bromide of ammonium, should be used 
with other drugs, 77, 613 
of calcium, 120 
of gold, 121 

of iron, when anaemia is present, 613 
of lithium, highly recommended in 

some cases, 121, 613 
of nickel, 613 

of potassium, the most reliable, in as- 
cending dose, 117, 611 
of sodium, not so apt to disorder stom- 
ach, 613 

Cannabis indica, 614 

Chloral, alone or with bromides, well di- 
luted, after meals, used with care, 154, 
616 

Diet, 617 

Digitalis, with bromides, useful in some 
cases, 614 

Duboisine, especially in psychic forms, 219 

Hydrobromic acid, liable to derange diges- 
tion, 613 

Iodide of potassium, useless except in 
syphilitics, 616 

Mercury, associated with potassium iodide, 
when due to gumma, 616 

Mixed treatment, 613 

Monobromated camphor, 134 

Nitro-glycerin, useful in some cases of 
petit mal, 325, 615 

Opium with gelsemium, only to be used 
when other * remedies fail ; also a pro- 
longed course of, in ascending doses, 
useful in old cases, 614 

Potassium nitrite, 324 

Quassia injections, when due to worms; 
if not obtainable, sodium chloride solu- 
tion may be used, 617 

Silver nitrate, may be tried when other 
remedies fail, 321, 615 

Solanum carolinense, fluid extract of, 2 to 
15 minims (0.1-1.0), 'thrice daily, in 
the epilepsy of childhood, 399, 617 

Strontium bromide, 403 

Tartar emetic ointment, as a counter-irri- 
tant at back of neck, 85 

EPISCLERITIS, 618 
Atropine locally, 618 
Antiseptic collyria, 618 
Iodide of potassium and salicylates, 618 

EPISTAXIS, 618 

Acetanilid, used locally, has been recom- 
mended, 55 



830 



INDEX OF DISEASES AND REMEDIES. 



Acetic acid, locally applied, to arrest, 56 

Aconite or veratum viride, tincture, TT\, 2 
to 4 (0.1-0.2), in sthenic cases, followed 
in thirty minutes by smaller doses, if 
necessary, 60, 618 

Alum powder, pure or half-and-half with 
starch, as a snuff, 619 

Bacon fat inserted as a plug in nostril, 
may arrest, 619 

Compression of facial artery may be nec- 
essary, 619 

Ergot, turpentine, hamamelis, or oil of 
erigeron, internally, in slow oozing, 
222, 619 

Hot foot-bath, or hot- or cold-water bags 
applied to dorsal vertebrae, may arrest, 
619 

Ice applied to nose, may arrest, 619 

Ipecac, in nauseating doses, recommended, 
619 

MonsePs solution, in spray (ir^ 30 to 4 
ounces [2.0 : 120.0] ), only to be tried 
when other remedies fail ; very dis- 
agreeable, 279, 619 

Oil of erigeron, 223, 619 

Plugging anterior and posterior nares, if 
necessary, with cotton or lint soaked in 
vinegar, 619 

Tannic acid, in powder or solution, snuffed 
up nostril, 619 

Vinegar or lemon -juice injected into nos- 
tril, 619 

EPITHELIOMA. 

Acid nitrate of mercury, applied to part 

with glass rod, 311 
Arsenous acid and gum acacia (of each 1 

ounce [30.0] to water 5 fluidrachms 

[20.0]), locally applied, 98 
Eesorcin, in epithelioma of the face, 376 

ERYSIPELAS, 619 

Alcoholic stimulants if patient passes into 
typhoid state, 620 

Antipyrin, to control fever, 620 

Antistreptococcic serum, 441 

Bitters and iron, during convalescence, as 
tonics, 620 

Boric acid, as a lotion, 113 

Cold bathing to control excessive fever, 
620 

Ichthyol ointment and vaseline, half-and- 
half, locally applied, preceded by wash- 
ing with castile soap, followed by bi- 
chloride solution (1 : 1000), 260, 620 

Iodine, tincture, painted around inflamed 
edges, to arrest, 267 

Iron, tincture of chloride, TT\, 20 to 40 
(1.3-2.6), thrice daily, best internal 
treatment, 277, 620 

Pilocarpine, gr. £ to * (0.008-0.01), hypo- 
dermically, contraindicated in debility ; 
also injected around borders of inflam- 
mation in some cases, to arrest, 366,620 

Silver nitrate, solution (gr. HO to the £ 
ounce [5.3:15.0]), applied twice or 
thrice, to arrest, 321, 620 

Veratrum viride or aconite, in early stages 
of st henic cases, 620 

White lead paint, locally applied, when 
ichthyol is not at hand, 620 



EXHAUSTION AND DEPRESSION, 621 

Stimulants, 621 

EXOPHTHALMIC GOITRE. 

Belladonna relieves some cases, 108 
Sparteine, 391 

EYE-STRAIN, 621 

Correct error of refraction, 621 

FAINTING. 
Alcohol, 63 

FEET (SWOLLEN, TENDER, OR SWEAT- 
ING), 621 

Arsenic, gr. fa to ^ (0.001-0.0015), in 
swelling of old persons, 622 

Borax, stockings soaked in saturated solu- 
tion and dried, each day, when sweat- 
ing is excessive, 622 

Carbonate of calcium, precipitated, locally 
applied to sweating feet, 128 

Cotton instead of woollen stockings may 
aid cure, 622 

Formaldehyde, 622 

Hamamelis, distilled or fluid extract, 
drachm i to 1 (2.0-4.0) of former, or 
TTL 10 to 20 (0.65-1.3) of latter, 622 

Lead plaster and linseed oil, equal parts, 
applied on linen to feet, every third 
day, for sweating, 289 

Prescription for dusting-powder, 622 

Best, absolute, of feet, may be necessary in 
swollen feet, 622 

Salicylic acid and borax, equal parts, in 
water and glycerin, best application to 
sweating and tender feet, 622 

FELON. 

Bread-crumbs saturated with liquor plumbi 
subacetatis, as a poultice, to abort, 289 

Silver nitrate, solution, applied early, to 
abort, 322 

FEVER, 622 

Acetanilid, 54, 623 

Aconite, the best depressant for sthenic 
types in children, 60 

Alcohol, as a systemic support and stimu- 
lant in low fevers, 63 

Ammonia for sudden cardiac failure in, 75 

Antimonial powders as an antipyretic, 85 

Antipyretics, useful in most sthenic fevers, 
often fail in thermic fever, 623 

Antipyrin, 88, 623 

Brand's method, 453 

Camphor a diffusible stimulant in ady- 
namic fevers, 132 

Coca a supportive and stimulant in low 
fevers, 192 

(bid applications and baths, 622, 623 

Cold packs and baths, in asthenic types to 
be relied on first ; if impracticable, then 
antipyretics, 623 

Digitalis, in small doses, valuable in ex- 
hausting fevers, 216 

(inaiacol, useful in, 246 

Hydrochloric acid an adjuvant to diges- 
tion, 253 



INDEX OF DISEASES AND REMEDIES. 



831 



Musk, by rectal injections, valuable in low 
stages, 316 

Neutral mixture, useful as a febrifuge, es- 
pecially in children, 372 

Phenacetin, 356 

FIBROIDS. 

Ergot, used as an expulsive and curative 

remedy, 222 
Mammary gland, for effect on bleeding and 

growth, 296 

FLATULENCE. 

Aromatic powder, 185 

Asafcetida, 101 

Camphor, 132 

Capsicum, prevents formation of gas, 139 

Charcoal, 145 

Chloroform, tt\, 1 to 2 (0.05-0.1), or spirit. 

TTl, 10 to 20 (0.65-1.3), will relieve, 171 
Cloves, a useful tonic and stimulant, 187 
Ginger, 242 
Hoffmann's anodyne, the best carminative, 

249 
Ipecac, 273 
Pepper, 351 
Peppermint, 352 
Podophyllin with euonymin, leptandra, 

chirata, and creosote, 370 
Potassium permanganate, 354 
Turpentine, prescriptions for, 423 

FRECKLES AND CHLOASMA, 625 

Almonds, emulsion of, supposed to be of 
value, 69 

Boric acid, saturated solution, applied same 
as corrosive sublimate wash, 114, 625 

Corrosive sublimate (gr. 1 to 4 to the ounce 
[0.05-0.25:30.0]), applied night and 
morning until irritation appears, then 
stop for some days and again renew, 
625 

Lactic acid (gr. 10 to the drachm [0.65 : 
4.0]), applied same as corrosive subli- 
mate, 625 

Prescription for chloasma of pregnancy, 346 

Prescriptions for, 625 

FURUNCLES. (See Boils.) 

GALACTORRHEA, 729 

Antipyrin, gr. 2\ (0.125), thrice daily, said 
to decrease secretion, 729 

Caustic, introduced into uterus, successful 
in some cases by inducing menstrual 
flow, 729 

Chloral should be tried, 729 

Compression of gland with applications of 
belladonna ointment and potassium 
iodide internally, usually relieves, 729 

Diet, 729 

Electricity, generally ineffective. 729 

Ergot, long continued, highly recom- 
mended, 729 

Malt, wineglassful at midday and evening 
meals, useful addition to diet ; pyro- 
phosphate of iron, gr. 4 (0.3), in addi- 
tion, if ansemia is present, 729 

Warm douches, 729 



GANGRENE. 

Bromine, as an escharotic in hospital gan- 
grene, 122 

Carbolic acid or creosote, spray (tt\, 5 to 10 
to the ounce [0.3-0.65 : 30.0]), useful in 
pulmonary gangrene, 143 

Nitric acid, to destroy tissue, 323 

GASTRALGIA, 626 

Acetanilid, 54 

Alum, 72 

Arsenic with iron, the most reliable rem- 
edy, prescription for, 626 

Bismuth and pepsin, after meals, to pre- 
vent pain, 111, 626 

Bromide of strontium, a valuable remedy, 
403 

Bromides or valerian, alternated with other 
treatment if case is neurotic, 627 

Cannabis indica, prescription for, 136 

Chloretone, gr. 5 to 10 (0.30-0.65), is useful, 
626 

Cod-liver oil in emulsion with hypophos- 
phites, occasionally better than arsenic 
and iron, 626 

Counter-irritation and a vigorous revul- 
sive, especially useful in hysteria, 626 

Cyanide of potassium, dilute hydrocyanic 
acid or chloroform as a substitute for 
bismuth, if it favors constipation, 627 

Diet and hygiene, 626 

Emesis and purgation, when due to indi- 
gestible food, 626 

Hot applications, stimulating infusions, 
chloroform, hot brandy or whiskey or 
laudanum, X 30 to 40 (2.0-2.65), dur- 
ing acute stage, 626 

Hydrocyanic acid, useful in nervous types, 
255 

Massage, enemata, diet, or suppositories of 
gluten, glycerin, or soap, to overcome 
constipation, 626 

Menthol, 352 

Nitro-glycerin, 325 

Potassium nitrite, gr. 4 to 5 (0.25-0.3), 324 

GASTRIC CATARRH (ACUTE), 627 

Ammonium muriate, useful in subacute 
forms in children, prescription for, 78 

Diet, principal point in treatment, 627 

Effervescing draughts, useful in convales- 
cence, 627 

Emetic, mild, to dislodge fermenting mass, 
if present, 628 

Flannel to protect abdomen, 628 

Ice, to quench thirst, if anorexia is great, 
627 

Iron, if anaemia exists, 628 

Milk, with large percentage of lime-water, 
627 

Pepsin and hydrochloric acid, 628 

Salicylic acid, valuable in vomiting, 382 

Salt, in moderation, in food, 628 

Seidlitz powder, one-fourth of one powder 
every fifteen minutes, to settle stomach 
and remove fermenting mucus, 628 

Sodium bicarbonate with gentian, useful, 
627 

Spice poultice to relieve epigastric distress, 
628 



832 



INDEX OF DISEASES AND REMEDIES. 



Tartar emetic, given early, in acute attack 
of children, may abort, 85 

GASTRIC CATARRH (CHRONIC), 628 

Apornorphine, as an emetic, to throw off 

mucus, 93 
Arsenic for the vomiting, in hand-fed 

babies, 97 
Bicarbonate of sodium for hyperacidity, 628 
Bismuth subnitrate, added to prescription, 

if hyperacidity exists, 628 
Carlsbad salt, Saratoga-Carlsbad water, or 

Seidlitz powder of great benefit, 628 
Cascara sagrada, if constipation exists, 628 
Charcoal, prescription for, 145 
Diet, such as kouinyss, light broths, and 

matzoon, 628 
Hydrochloric acid, if due to atrophy of the 

gastric tubules, 253, 629 
Lavage almost always to be used, 628 
Silver nitrate and hyoscyamus, with coun- 
ter-irritation and regulated diet, 258, 

321, 628 

GASTRIC DILATATION, 629 

Cold douches, 630 

Diet, 629 

Enemas, nutrient, often useful, especially 
in older children, 629 

Exercise, 630 

Faradization of gastric walls recently in- 
troduced, 629 

Hydrochloric acid, to aid digestion, 629 

Lavage, 629 

Taka-diastase taken with meals, 629 

GASTRIC ULCER, 630 

Arsenic, 97 

Bismuth and sodium bicarbonate, as an as- 
tringent and sedative, and to these may 
be added morphine or codeine for pain, 
111, 631 

Carlsbad salts, magnesium sulphate, or so- 
dium phosphate, for relief of constipa- 
tion, 631 

Cocaine, gr. } (0.016), alone or combined 
with bismuth, to control vomiting, 631 

Cold compresses or an ice-bag applied to 
epigastrium in hsematemesis, 631 

Counter-irritation, continuous, over belly, 
to relieve pain, 631 

Creosote or carbolic acid, for vomiting, 631 

Diet and hygiene, 630 

Massage and electricity, 630 

Monsel's solution, cold compresses, adrena- 
lin chloride, or turpentine, may be 
given to check hematemesis, 631 

Morphine for pain or collapse following 
perforation, 632 

Rectal alimentation, of great service, 630 

Resorcin useful in some cases, 376 

Real for the patient and rest for the stom- 
ach essential, (530 

Silver nitrate with hyoscyamus in pill, 
half to one hour before meals, 631 

spice plaster, useful as a continuous coun- 
ter-irritant, 631 

Stimulants, cardiac, guardedly adminis- 
tered, external heat and rubbing, in 
collapse following hemorrhage or per- 
foration, 632 



GASTRITIS (ACUTE), 632 

Belladonna or atropine, internally, and 
flaxseed poultice over epigastrium and 
chest, if collapse threatens, 632 

Bismuth, as an astringent and sedative, 111 

Flaxseed tea, a useful demulcent, 237 

Mucilaginous drinks and albuminous sub- 
stances freely given, 632 

Oils, to prevent spread of inflammation, 
632 

Opium, in fluid form, to relieve pain and 
irritation, 632 

Paregoric contraindicated, 632 

Warm water, internally, or stomach-pump, 
to unload stomach at onset, 632 

GASTRO-ENTERITIS, 632 

Castor oil or magnesium sulphate, to sweep 
out poison, 633 

Morphine, hypoderrnically, to allay pain, 
followed or preceded by mild, rapidly 
acting emetic, if irritating substance 
remains, 633 

Opium, with hot applications or plasters to 
belly, to control irritation and diar- 
rhoea, 633 

Predigested foods, 633 

GASTRO-INTESTINAL CATARRH. 

Carlsbad, Vichy, or other alkaline mineral 
water of purgative powers, often useful, 
498 

Diet for seven-year-old child, 516 

Garlic, as a poultice to belly almost equal 
to spice poultice, 68 

Gentian with bicarbonate of sodium useful 
in children, 241 

Hydrastis, especially useful if due to alco- 
holism, 252 

Salicylate of bismuth in the presence of 
fermentation or putrefaction, 112 

Sanguinaria, of service if jaundice is pres- 
ent, 387 

Sodium bicarbonate, 10 to 20 grains, 396 

Tar, in 2-gr, (0,1) pills, 369 

GIDDINESS. 

Cod-liver oil with quinine, valuable in old 

age, 196 
Ergot and bromides useful, 222 

GLANDS (DISEASED). 

Ammoniac plaster, as a stimulant to en- 
larged glands, 76 

Ammonium iodide and glycerin (gr. 30 to 
the ounce [2.0 : 30.0]), locally applied to 
enlarged tonsils, 79 

Carbolic acid (2 per cent, solution), injected 
into glands threatening suppuration, 
144 

Cod-liver oil, in lymphatic enlargements, 
195 

Ichthyol ointment, valuable as an inunc- 
tion in lymphatic enlargements, 260 

Iodine, the best remedy for enlargements, 
265 

Mercury ointment as an inunction in en- 
larged glands, 311 

Potassium iodide for enlargements of the 
cervical glands, 263 



INDEX OF DISEASES AND REMEDIES. 



833 



GLAUCOMA, 633 

Atropine, contraindicated, 633 

Eserine (gr. 1 to 2 to the ounce [0.05-0.1 : 
30.0]), or pilocarpine nitrate (gr, 2 to 4 
to the ounce [0,1-0.2:30.0]), dropped 
into eye if operation is delayed, 362, 
633 

Hot compresses, leeches, and opiates to re- 
lieve pain, 633 

Iridectomy, the only curative treatment, 
633 

Pilocarpine in, 365, 633 

GLEET. 

Bichloride of mercury, injection (gr. \ to 
water ounces 6 [0.025 : 180.0]), every 
three or four hours, 306 

Cantharidal collodion, applied to under 
surface of penis, or perineum, 461 

Cantharis, 13S 

Sandalwood oil, 386 

Turpentine, internally, 423 

Uva ursi, 425 

GOITRE. (See Bronchocele.) 
GONORRHOEA (ACUTE), 633 

Aconite, TIL 2 (0.1), every two or three 
hours, if inflammation is high, 636 

Almond emulsion, diminishes burning on 
urination, 69 

Benzoic acid, with cannabis indica, useful 
in later stages, 110 

Bicarbonate of sodium or potassium citrate, 
gr. 10 (0.65), after meals, increasing, if 
necessary ; relieves ardor urinse, 636 

Cannabis indica, often used in later stages 
instead of copaiba and cubebs, 136 

Cinnamon oil, by injection or spray, 186 

Cocaine, solution (4 per cent.), instilled 
into urethra before urination, dimin- 
ishes ardor urinee, 636 

Copafba and cubebs, useful, 203, 209, 635 

Diet and hygiene, 636 

Erigeron oil, occasionally used instead of 
copaiba and cubebs, 223 

Eucalyptus, valuable in subacute stages, 
234 

Hot sitz-bath, prolonged, and hot- water 
injections, useful in females, 636 

Hydrastis, one of the best remedies, locally 
and internally in later stages ; also as 
a vaginal wash for females, 252, 635 

Lead acetate, injection, gr. 1 to 8 to the 
ounce (0.065-0.5 : 30.0), 288, 635 

Lead-water and laudanum, or alcohol and 
water, applied on a cloth to penis, dur- 
ing inflammation, 635 

Mercurol, 297 

Mercury bichloride (1 : 20,000 or 1 : 40,000), 
in large quantities to flush urethra ; in 
females, 2 pints of solution (1 : 4000), 
thrice daily, to irrigate vagina, 634 

Nargol or protargol injections (gr. iii. to 3 
ounces), 635 

Opium or belladonna, hypodermically or in 
suppository, to control pain in posterior 
urethritis, at same time discontinuing 
active treatment, and observing strict 
hygiene and diet, 636 

53 



Permanganate of potassium solution (1 : 
6000), as an antiseptic, 634 

Prescription for administration of balsams, 
635 

Prescriptions for checking the discharge, 
635; for injection for posterior ure- 
thritis, 637 

Protargol, 373 

Quercus alba, injections, useful in females, 
375 

Salol, 385, 635 

Sandalwood oil, 635 

Silver nitrate, injections (gr. i to 1 to the 
ounce [0.015-0.05 : 30.0]), useful in sub- 
acute stage ; in females, gr. 4 to 40 to 
the ounce (0.25-2.65 : 30.0), painted over 
vagina, followed by astringent cotton 
tampon, 322, 637, 642 

Urinating with penis in hot water, to re- 
lieve ardor urinee, 636 

Warm baths, lasting one-half to two hours, 
useful in early stage, 636 

Zinc acetate, injection, gr. 1 to 20 to the 
ounce (0.05-1.3 : 30.0) of rose-water, 430 

Zinc chloride, injection, gr. 1 to 2 to the 
ounce (0.05-0.1 : 30.0), occasionally used 
in second stage, 431 

Zinc sozoiodol, 2 per cent, solution, 399 

Zinc sulphate, weak solution, as an astrin- 
gent, 431, 635 

GONORRHOEA (CHRONIC), 637 

Bichloride of mercury useful in, 306 

Copper sulphate or silver nitrate, solution, 
as an application, after dilatation, to 
focus of inflammation, 638 

Dilatation, if stricture exists, 637 

Irrigations daily with nargol or protargol 
(1:3000 to 1:500), silver nitrate (1 : 
1000), mercurol (1 : 2000) or potassium 
permanganate (1 : 2000 to 1 : 500), 638 

Prescriptions for, 638 

Pressure and use of cold, often valuable, 
638 

Sandalwood oil, to stimulate depraved mu- 
cous membrane, 3S6 

Silver nitrate, solution, if discharge per- 
sists after dilatation ; also in posterior 
urethritis, 638 

Unna's treatment with coated sounds, pre- 
scription for, 638 

Uva ursi, 425 

GOUT, 642 

Antipyrin, said to have a specific effect, 89 

Chloral, in insomnia, 643 

Chloroform liniment, applied over affected 

part, 172 
Cod-liver oil, 196, 644 
Colchicum, wine of the root, n\ 20 (1.3), 

increasing by TT\, 1 (0.05) every four 

hours, until symptoms are relieved or 

appear toxic, in acute types, 198, 643 
Collodion, not more than one or two coats; 

also useful with iodine, 199, 643 
Colocynth with hyoscyamus to unload the 

bowels, prescription for, 200 
Diet, 643 
Fowler's solution, Tn^ 3 (0.15), in water, a 

standard remedy in subacute and 

chronic types, 643 



834 



IXDEX OF DISEASES AXD REMEDIES. 



Gentian. 241 

Hot air. valuable. 461 

Iodide of iron, syrup of, and cod-liver oil 
if anseruia is present. 644 

Iodide of potassium, to relieve night pains ; 
also with colchicuni. in chronic gout, 
643 

Iodide, ointment or tincture, locally ap- 
plied to chronic gouty joints, 643 

Leeches or venesection, contraindicated, 
643 

Lithium carbonate or citrate igr. 5 to 10 
to the ounce [0.35-0.65 : 30.0]), locally 
applied, to dissolve deposit around 
joints. 292. 643 

Morphine, hypodermically, to relieve acute 
pain, 642 

Peppermint oil, locally applied, 643 

Potassium bromide, the best remedy for 
insomnia, 643 

Potassium permanganate, 354 

Salicylates in large dose mav be useful in. 
381 

Sodium bicarbonate and linseed oil (1:9), 
locally applied to joints. 643 

Stimulants, ether hypodermically, opium 
except in brain or kidney disturbances ; 
diuretic and alkaline drinks and coun- 
ter-irritation, in retrocedent gout, 644 

Water, distilled or medicinal, in large 
amounts. 642 

GRANULAR LIDS. (See Conjunctivitis. 
Granular. ) 

GRAVES'S DISEASE. iSee Exophthal- 
mic Goitre.) 

GRIPING. 

Allspice or ginger, to prevent griping of 
purgatives, 6S. 242 

GROWTHS (PATHOLOGICAL). 
Acid nitrate of mercury. 311 
Caustic potash, or soda, occasionally used 

to destroy, 149 
Chromic acid, as a caustic, to destroy 

growths on skin or mucous membranes, 

176 
Lime as an escharotic on hairy growths, 131 
Methylene blue. 314 
Nitric acid, 323 
Pvoktanin. 314 
Sodium ethvlate to remove hairy growths, 

397 
Thiosinamine has been used with some 

success in malignant growths, 417 

GUMS (DISEASES OF). 

Burnt alum, useful if applied to swollen 
ir u t n - . 72 

Catechu, as a mouth-wash, for spongy 
gum-. 1 19 

Cocaine, locally applied, in soreness and 
tenderness of gums, 189 

Iodine, solution (gr. 1 to the ounce [0.05: 
30.0]), locally applied, followed by rins- 
ing mouth, when gum8 arc retracted. 
267 

Myrrh, tincture, locally applied, to spongy 
or tender gums, :U7 



HAY FEVER. 

Arsenic, 97 

Cocaine, with bismuth and morphine, as a 

snuff, 189 
Eesorcin, solution, 2 per cent., in spray, 

375 
Terpine hydrate, in full dose, 415 

HEADACHE, 644 

Acetanilid. 54 

Belladonna, valuable in young people, 106 

Bleeding, 645 

Caffeine, with antipyrin or sodium bro- 
mide, in nervous headache, 126, 645 

Camphor, with acetanilid or antipyrin, in 
nervous headache. 133 

Cannabis indica. when at menopause or 
due to retinal asthenopia, 136 

Capsicum plaster to nape of neck, 140 

Cimicifuga. if due to eye-strain, 178 

Colchicuni, in gouty headache, 646 

Croton chloral, if due to eye-strain or as- 
sociated with sick stomach, 208 

Cup, to nape of neck, in congestion, 645 

Ergot, if due to congestion, 222, 644 

Eucalyptus, if headache be rheumatic or 
malarial, 234 

Gelsemium, if due to nervous troubles or 
eye-strain. 240 

Horseback exercise and sleep very useful 
in obtaining relief from nervous head- 
ache, 645 

Hydrobromic acid, if due to eye-strain in 
nervous women, 121 

Ice-bag, applied to head, or leeches behind 
ears, in severe cases. 645 

Kola, very useful in elixir or tincture for 
sick and neuralgic headaches, 284 

Liquor magnesii citratis. in sick headache, 
295 

Magnesium carbonate, gr. 5 to 60 (0.3-4.0), 
in sick headache due to gastric aciditv, 
294 

Mustard foot-bath and plaster to nape of 
neck, in congestion, 317. 644 

Xux vomica, gtt. 1 (0.05), every five or ten 
minutes till 10 minims (0.65) are taken 
in sick headache, 334 

Phenacetin, if due to eye-strain or neural- 
gia, 356 

Potassium bromide, 118 

Prescriptions for. 645, 646 

Salicylic acid or iodide or acetate of potas- 
sium, if due to gout, 645 

Sodium bicarbonate, as an antacid in sick 
headache, 396 

Strychnine or nux vomica, in sick head- 
aches or if due to eye-strain, 334, 645 

HEART DISEASE, (J hi 

Aconite or veratrum viride, often useful in 
palpitation and hypertrophy. 60. 651, 

652 
Adonidin, often of service when digitalis 

fails, (il. 649 
Ammonia and ether, followed by digitalis 

and alcohol, in heart failure. 75, 650 
Arnyl nitrite, in single whiffs, often relieves 

cardiac failure, B0 
Barium chloride, in heart failure, 103 



INDEX OF DISEASES AND REMEDIES. 



835 



Baths by Schott's method ; formula for, 
653, 654 

Belladonna, when arhythmia is present, 
651 ; in palpitation, 106 ; plaster in 
hypertrophy, 651 

Cactus grandiflora, useful in valvular dis- 
ease with incompetency, cardiac weak- 
ness and palpitation, 124, 650 

Caffeine, very useful, 126, 651 

Camphor in palpitation, 132 

Cimicifuga, as a tonic in fatty and irritable 
heart when digitalis fails, 178 

Citrate or bitartrate of potassium with 
digitalis when secretion of urine is 
scanty, 651 

Convallaria majalis, in cardiac arhythmia, 
203 

Diet, exercise, and hygiene, 653 

Digestive remedies, in palpitation due to 
indigestion, 650 

Digitalis, to be tried in all heart troubles, 
except in simple or compensatory 
hypertrophy, 215, 647 

Hoffmann's anodyne, very useful in palpi- 
tation due to indigestion or tobacco, 
249 

Hydragogue cathartics for the dropsy and 
portal engorgement, 650 

Iodides to relieve tension in fatty heart, 
652 

Iron, arsenic, and simple bitters for asso- 
ciated debility and anosmia, 650 

Iron in palpitation due to anaemia, 650 

Kola, useful in cases with debility, 284 

Mtro-glycerin, when arterial tension is 
high, 650, 651 

Nux vomica, as a stimulant, 653 

Opium, if dyspnoea prevents sleep, 340 

Potassium bitartrate or citrate with digi- 
talis for scanty secretion of urine, 651 

Best in bed essential when aconite is used, 
652 

Sparteine, in arhythmia or palpitation, 
also as a substitute for digitalis, if it 
fails, 391, 649 

Strophanthus, if digitalis fails, 404, 649, 
650 

Suprarenal gland, 410 

Venesection followed by digitalis for over- 
distended right ventricle, 650 

Veratrine ointment, locally in palpitation, 
650 ; in hypertrophy, 651 

Veratrum viride, 428 

HEMATEMESIS, 658 

Adrenalin, 658 

Ergot, hamamelis, or ipecac, in slow bleed- 
ing, 659 

Ice, cracked, swallowed frequently, accom- 
panied by Monsel's solution, IT^ 3 (0.15), 
in a half-tumblerful of water, every 
fifteen minutes, 658 

Iron, tincture of chloride, or turpentine, 
internally, 659 

Lead acetate with morphine or opium, gr. 
2 to 3 (0.1-0.15), in pill, 659 

Monsel's salt, gr. 2 to 3 (0.1-0.15), in pill, 
279, 659 

Silver nitrate, gr. I (0.015) in pill, in slow 
bleeding, 659 



Tannic acid, gr. 20 (1.3) to drachm (4.0) ; 
must not be given with Monsel's solu- 
tion, 658 

HEMATURIA, 660 

Alum, gr. 2 to 3 (0.1-0.15) to water 1 ounce 

(30.0), injected into bladder, if alarm- 
ing, 661 
Astringent injections, should be used only 

when bleeding is alarming, 661 
Camphor, gr. 10 to 20 (0.6-1.3), in divided 

doses, in pill, 661 
Cannabis indica, useful in some cases, 661 
Ergot, 660 
Erigeron, 660 
Gallic acid, gr. 20 (1.3), very valuable, 238, 

661 
Hamamelis, injected daily into bladder, or 

used internally, 248 
Hyposulphite of sodium, 5 to 15 gr. (0.3- 

1.0), if due to malaria, 398, 661 
Morphine and atropine hypodermically 

and cups over kidneys in hematuria, 

661 
Prescription for, 661 
Quinine, usually harmful, unless due to 

malaria, 661 
Rhus aromatica, 377 
Turpentine, 423, 660 

HEMOPHILIA. 

Calcium chloride, 128 

HEMOPTYSIS, 657 

Acetanilid, has been recommended, 55 

Aconite, to prevent pneumonia following, 
contraindicated in exhaustion, 658 

Alum, solution (gr. 20 to the ounce [1.3: 
30]), in fine spray, 72 

Chloral and bromides, to allay nervous ex- 
citement, 658 

Ergot, fluid extract, 1 to H drachms (4.0- 
6.0), internally, 657 

Esmarch bandages to limbs when aconite 
cannot be used because of exsanguina- 
tion, 658 

Gallic acid, gr. 20 to the ounce (1.3 : 30.0) 
of water, when ergot is not at hand, 
238, 657 

Hamamelis, 248 

Ice or dry cup over bleeding spot, 658 

Ice or ice-cold compresses to the scrotum 
or vulva in, 658 

Ipecac, in small doses, very effective, 273 

Morphine, hypodermically, to allay ner- 
vousness and cough, 340, 658 

Tannic acid, Monsel's solution, or alum, 
used in spray, as styptics, prescriptions 
for, 279, 413, 657 

HEMORRHAGE, 655 

Alum, a useful styptic, applied to bleeding 

vessel, 70 
Antipyrin, 90 
Arnica, 94 

Cinnamon in uterine hemorrhage, 186 
Compress, soaked in antiseptic liquid or 

filled with antiseptic powder, preferable 

to styptics, 655 



836 



INDEX OF DISEASES AND REMEDIES. 



Gelatin, locally and hypodermically, to aid 

in the coagulation of blood, 656 

Hainarnelis, useful for uterine oozing, and 
bleeding from the bladder, 248 

Hypodernioelysis, 656 

Ligation preferable to styptics, when appli- 
cable, 655 

Monsel's solution, 279 

Oil of erigeron, 223 

Packing of astringents, if bleeding point 
cannot be reached by compression, or 
for ligation, 655 

Sulphate of sodium, by the mouth or intra- 
venously ; useless hypodermically, 398 

Tannic acid, 413 

Transfusion, 504, 656 

HEMORRHAGE (INTESTINAL), 659. (See 
also Hemorrhage.) 

Chloride of calcium, 659 

Enemas, styptic, for hemorrhage from rec- 
tum or colon ; alum (gr. 10 to the ounce 
[0.65 : 30.0]), copper (gr. 5 to the ounce 
[0.3:30.0]), Monsel's solution (dr. \ to 
2 ounces [2.0 : 60.0]), Monsel's salt (gr. 
10 to the ounce [0.65 : 30.0], or drachm \ 
[2.0] to water 2 ounces [60.0]), chlorate 
of potassium (gr. 10 to 25 to the ounce 
[0.6-1.6 : 30.0]), tannic acid (gr. 20 
to ounce [1.3:30.0]), of glycerin and 
water, 659 

Ergot, 659 

Ice, by mouth, and to the belly, and Mon- 
sel's salt, gr. 3 (0.15), in hard pill, every 
half-hour or oftener, 659 

Ice-water injections in bloody purging of 
dysentery, 659 

Lead acetate and camphor, in pill, of ser- 
vice in some cases, 659 

Monsel's solution not advisable, 279 

Sulphuric acid, gtt. 5 to 10 (0.3-0.65) in 
water, 659 

Tannic acid, when Monsel's salt is not at 
hand, 659 

Turpentine, in capsule or emulsion, when 
bleeding is not active, 423, 659 

HEMORRHOIDS, 662 

Aloes, 70 

Carbolic acid injection dangerous, 663 

Cocaine and iodoform ointment, prescrip- 
tion for, 662 

Cold-water injections in the morning, re- 
lieve congestion and cause easy evacua- 
tion, 446. 662 

Ergot, sometimes useful in bleeding piles, 
222 

Gallic acid and ointment of stramonium, 
equal parts, 238 

Gallic acid and opium suppository, pre- 
scription for, 662 

Hamamelis, internally or as a lotion or in- 
jection, 248, 663 

Hygiene and general rules, 662, 663 

Iodoform suppository, if ulceration is pres- 
ent, 273 

Lead-water and laudanum lotion after 
acute stage is passed, n'63 

Linseed oil, 237 

Nitric acid, lightly touched to one or two 
points, 324, 662 



Potassium chlorate, with laudanum, as an 

injection, 158 
Poultice, to effect reduction, 663 
Quercus alba, as an astringent wash, 375 
Stillingia, prescription for, 402 
Sulphur, to produce soft passages, 407 
Tannic acid, suppositories in bleeding piles, 

413 

HEPATIC ABSCESS, 644 

Active treatment for dysentery, if present, 

664 
Ammonium muriate, thought to be of 

value, 78 
Aspiration, when pus forms, 664 
Diet, 664 
Quinine and iron, after abscess develops, 

664 

HEPATIC CIRRHOSIS. 

Ammonium chloride, 78 
Iodoform, highly recommended, 270 
Xitro-muriatic acid, in early stages. 326 
Potassium iodide, often useful in early 

stages, 263 
Sodium phosphate very useful, 358 

HEPATITIS (ACUTE), 663 

Aconite in early stages, 664 

Cantharidal blister, small, over right hypo- 
chondrium ; if impracticable, use mus- 
tard plaster, 664 

Hot cloths, over counter-irritant, may re- 
lieve pain and aid in formation of blis- 
ter, 664 

Saline purgatives, preceded by calomel, gr. 
1 (0.05), in divided doses, if constipation 
exists, 664 

Sweet spirit of nitre with potassium ci- 
trate, or diuretic waters, to regulate 
kidneys, 664 

Veratrum viride, 428, 664 

HEPATITIS (CHRONIC AND SUBACUTE), 
664 

Ammonium chloride, useful in subacute 
forms, 78 

Antisvphilitic treatment, if due to syph- 
ilis, 665 

Aspiration, frequently repeated, may effect 
a cure, 665 

Nitro-muriatic acid, internally and exter- 
nally, most useful remedy, 326, 664 

Potassium iodide, useful in all cases, 665 

HERNIA. 

Chloroform or ether inhalations, to relax 
muscles during reduction, 168, 229 

HICCOUGH, 665 

Amvl nitrite, 665 

Belladonna, 108 

Camphor, spirit of. dose 1 drachm (4.0), 132, 
665 

Capsicum, tincture, u\ 2 to 3 (0.1-0.15), 
(Hi.-) 

Chloral, 151 

Chloroform, 665 

Emetics or purges when gastric or intesti- 
nal irritation is present, 665 



INDEX OF DISEASES AND REMEDIES. 



837 



Ether, sprayed on epigastrium, 665 

Hoffmann's anodyne, especially valuable, 
249, 665 

Musk, gr. 10 (0.65), given by rectum, valu- 
able in all cases, especially in typhoid 
fever, 316, 665 

Nux vomica, accompanied by mineral acids, 
if due to indigestion, 666 

Oil of amber, Tt^ 5 to 10 (0.3-0.65), in cap- 
sule, one of the best remedies, 73, 665 

Pilocarpine, hydrochlorate, hypodermically, 
or hot pack if due to uraemia, 666 

Valerian, tincture of, dose 1 drachm (4.0), 
665 

HYDROCELE. 

Iodine, injections, after evacuation of the 
sac, the best curative remedy, 267 

HYDROCEPHALUS. 

Potassium iodide, to cause absorption of 
fluids, 262 

HYSTERIA. 

Calcium bromide, 120 

Hops, as a nervous sedative, 251 

Monobromated camphor, to produce sleep, 

134 
Oil of amber, 73 
" Pill of three valerianates," recommended, 

426 
Potassium bromide, 117 
Valerian, 426 

Valerianate of ammonium, 79 
Valerianate of iron, if associated with 

anaemia, 280 

IMPOTENCE. 

Cannabis indica, with strychnine, nux 

vomica, or ergot, if no organic trouble 

exists, prescription for, 136 
Cantharis, with nux vomica and iron, may 

restore sexual power if loss is due to 

excess, 138 
Cold douche to perineum and testicles, in 

atonic types, 448 
Gold, chloride of, and sodium, gr. ^<j (0.003), 

244 

INCONTINENCE OF URINE, 666 

Alkalies, 666 

Ammonium benzoate or urotropin, gr. 4 

(0.3), in water, three times a day, if 

urine is concentrated and ammoniacal 

in odor, 667 
Antiseptic fluids, to cleanse bladder, in 

paralysis, 668 
Arsenic, with nux vomica, in weakness of 

spinal centres, prescription for, 667 
Belladonna, if due to vesical spasm, 108, 

666 
Bromides with chloral, if due to vesical 

spasm, 117 
Buchu, with sweet spirit of nitre, valuable 

in some cases, 123 
Cantharides, Yt\, 1 (0.05), with alkaline 

diuretics, thrice daily, in adults, 138, 

667 
Catheterization, in retention or paralysis, 

667 



Circumcision, if prepuce is redundant, re- 
lieves some cases, 666 

Diuretic waters, used for years, necessary 
in some cases, 666 

Fowler's solution, tt\, £ to 1 (0.025-0.05), in 
chronic types due to atony, 667 

Hyoscyamus, if due to irritable bladder, 
258 

Potassium citrate when due to acidity, 372 

Bhus aromatiea, in incontinence of chil- 
dren, due to atony, 377 

Santonin, often valuable when other reme- 
dies fail, 388 

Strychnine, 667 

Sweet spirit of nitre and potassium citrate, 
if urine is dark and concentrated, pre- 
scription for, 411^ 666 

Worms removed from vagina often cure, 
666 

INDIGESTION (GASTRIC AND INTES- 
TINAL), 668 

Alkalies, before meals in atonic states, dur- 
ing or after meals when the secretion of 
acid is excessive, 669 

Ammonium chloride, in painful forms, 78 

Asafoetida, in indigestion of old age, asso- 
ciated with flatulence, 101, 672 

Bicarbonate of sodium with bitters, 669 

Bitter tonics, useful in atony, contraindi- 
cated in gastric irritation, 669 

Bromide of strontium, in excessive secre- 
tion, when not due to ulcer, 403, 670 

Bryonia, when dependent upon gastric or 
intestinal atony, 123 

Carbolic acid and bismuth, 671 

Chirata, if liver is torpid or constipation is 
present, 151 

Chloral, creosote, sodium hyposulphite, or 
thymol, with lavage, when fermentation 
is excessive, 671 

Chloroform spirit, tti^ xx (1.3), often of 
great value, 673 

Diastase when starchy foods are not di- 
gested, 211 

Diet, 668 

Fats, excluded in fermentative types, 671 

Gold, chloride of, and sodium, when epi- 
gastric pain is present, 244 

Hydrochloric acid, combined with carda- 
moms, in atrophy of the gastric tubules, 
cancer, or intestinal dyspepsia, 669 

Hyoscyamus, belladonna, opium, bromides, 
and bismuth, when there is hyperacid- 
ity, 670 

Lavage, 671 

Leptandra, of great value in intestinal 
types, prescription for, 290 

Massage, 672 

Nitrate of silver, especially where an ulcer 
is present, 670 

Nitro-hydrochloric acid or nitric acid, val- 
uable in many cases, 323, 326, 672 

Ox-gall, 345 

Pancreatin, with sodium bicarbonate and 
alkaline mineral waters, in intestinal 
types, 672 

Papain, 350 

Podophyllin or mercury in lientery, 672 

Prescription for flatulence of intestinal in- 
digestion, 671, 672 



838 



INDEX OF DISEASES AND REMEDIES. 



Prescription for torpid liver of indigestion, ' 

672 
Khubarb, quinine, condurango, and nux 

vomica, useful tonics. 669 
Salol in intestinal form with, fermentation, 

385 
Serpentaria as a tonic, 394 
Test-meal as a means of diagnosis, 669 
Thymol, beta-naphtol, creosote, chloral, and 

sodium hyposulphite in acidity due to 

acids of fermentation, 671 
Volatile oils, prescription for, 672 
Yellow oxide of mercury, gr. ^ to -£ 

(0.001-0.0012), in trituration, if there is 

foul belching or ill-smelling stools, 312 

INFLAMMATION. 

Cannabis indica, valuable in chronic types, 
136 

Cocaine, in acute types, prescription for, 189 

Flaxseed for inflamed mucous membranes, 
237 

Hop poultice, 251 

Liquor plumbi subacetatis, useful as a top- 
ical application, 288 

Opium, 340 

Sulphurated lime, useful to check, 131 

Tartar emetic, in sthenic inflammation, 85 

Turpentine stupe, 423 

Veratrum viride, 428 

INFLUENZA, 673 

Aconite, sweet spirit of nitre, and citrate 
of potassium in combiuation, valuable 
in early stage, 674 

Alcohol, 676 

Antipyrin, phenacetin, and acetanilid 
should be used only in small doses to 
allay pain, 673 

Belladonna, combined with strychnine, if 
there be vasomotor paresis, 676 

Bromides, codeine or morphine, if cough be 
excessive, 677 

Cannabis indica. often valuable, if pushed, 
for irritative cough, 677 

Castor oil or magnesium sulphate for con- 
stipation, 677 

Chloral, cbloralamide, or sulphonal, for in- 
somnia, 677 

Cold bath, preferable to antipyretics for re- 
duction of temperature, 674 

Cups, contraindicated, 675 

Ergot, cannabis indica. with bromides, 
often relieve vertigo, 677 

Monobromated camphor, 134 

Phenacetin, 356 

Remedies for bronchitis when present, 677 

Salol and phenacetin, valuable in combi- 
nation, to allay irritation and pain, 674 

Sandalwood oil, for excessive cough, 386 

Steam inhalations, laden with vaporized 
drugs, for cough, 676 

Strychnine preferable to digitalis, if there 
he tendency to collapse, 676 

INSANITY. (See Mania, Acute.) 

INSOMNIA, 678 

Amylene hydrate, useless if due to pain, 
679 



Bath, cold, in cerebral anaemia, hot, in ner- 
vous irritability, 445 

Bromide of potassium with Fowler's solu- 
tion, in nervous females, prescription 
for, 678 

Cannabis indica, prescription for, 136 

Chloral, useful if not due to pain, prescrip- 
tion for, 154, 678 

Chloralamide, gr. 15 to 60 (1.0-4.0), in wine 
or capsule, in nervous insomnia, 155, 679 

Chloralose, 2 to 7 grains (0.1-0.5), in cap- 
sule, 156 

Chloretone, 158, 679 

Chlorobrom for insomnia of melancholia 
and acute mania, 156 

Croton chloral, preferable to chloral, if due 
to pain, 208 

Duboisine more useful than hyoscine, 218 

Hop pillow, 251 

Hot-water bags to feet and cold to head, or 
general hot bath, 679 

Hyoscine, gr. T ^ to ^ (0.0006-0.0007), by 
mouth, or gr. T ^ to T ^ (0.0004-0.0006), 
hvpodermically, in mania or hysteria, 

258, 678 

Hypnal. useful in insomnia due to pain, 

259, 679 

Morphine with chloral, if due to pain, pre- 
scription for, 678 

Opium, onlv to be used in pain, 339 

Paraldehyde, 350, 679 

Potassium bromide, in nervousness and 
overwork, 118 

Scopolamine, if due to nervousness, 390 

Somnal, minims 10 to 40 (0.65-2.6), in 
liquorice and water, 399, 679 

Sulphonal, prescription for, may be given 
in hot water, 406, 679 

Tetronal, useful, 421 

Trional, in 15-grain (1.0) doses, 421, 679 

Valerian, in nervousness, 425 

INTERMITTENT FEVER, 680 

Alcohol, contraindicated during chill, 681 

Anesthetization, has been employed to put 
off paroxysm, 682 

Arsenic, in intervals between attacks, as 
an an ti periodic, 96 

Calomel, gr. £ to i (0.01-0.016), every fif- 
teen minutes until 1 grain (0.05) is 
taken, four or five hours before quinine, 
if constipation is present, 681 

Chloroform inhalations, preceded by lauda- 
num, by mouth or rectum, or morphine, 
gr.£ (O'oi), with atropine, gr. ^ (0.001), 
hvpodermically, if death threatens dur- 
ing chill, 681 

Cool drinks and sponging, in fevered stage, 
cold with friction, 682 

Digitalis or strychnine, to relieve internal 
congestion during chill, 681 

Eupatorium useful in, 235 

Ipecac or zinc sulphate, as an emetic, if 
chill follows full meal, 681 

Methylene blue, 1 to 4 grains (0.05-0.2), 
31*4, 682 

Phenocoll, sometimes useful, 357 

Podophyllin, gr. ^ to £ (0.006-0.008), pre- 
ceding quinine, if constipation is pres- 
ent, 681 



INDEX OF DISEASES AND REMEDIES. 



839 



Potassium or sodium nitrite, gr. 10 (0.65), I 
has been employed to put off attack, ; 
682 

Quinine, as a prophylactic and antiperiodic, 
680 

INTERTRIGO. (See Chapping.) 

INTESTINAL CATARRH. 

Ammonium chloride, useful in subacute I 
types, 78 

Chlorate of potassium, injections (gr. 20 to 
the ounce [1.3 : 30.0]), in acute rectal 
catarrh, 158 

Iodide of potassium, if ammonium chlo- 
ride fails to relieve, 263 

Leptandra, fluid extract, dose 20 minims to 
1 drachm (1.3-4.0), 290 

Salol, 385 

INVOLUTION (ANOMALIES OF), 725 

Applications of nitric acid and silver ni- 
trate useful in lacerations, 726 

Cannabis indica, of great value in subinvo- 
lution, 136 

Cimicifuga in subinvolution, 178 

Curette in subinvolution due to retention 
of hypertrophic endometrium, 726 

Digitalis in subinvolution due to sluggish 
circulation, 726 

Ergot, quinine, and strychnine, in pill, if 
due to fibroids, 726 

Mammary gland, 296 

Purgatives, disinfectants, and possibly hot 
water locally applied, if due to inflam- 
mation, 726 

Eemoval of placenta, if adherent, 726 

IRITIS, 682 

Atropine, the best local remedy, 108, 682 

Daturine, scopolamine, or duboisine, when 
atropine cannot be used, 682 

Iced compress, in early stage of traumatic 
iritis, 682 

Iodide of potassium, alone or with mer- 
cury bichloride, following mercurial 
impression, in syphilitics, 633 

Leeches and dry heat or hot fomentations, 
to relieve pain, 632 

Mercury, preferably by inunction, if due 
to syphilis, 683 

Morphine, if pain is severe, 683 

Paracentesis, 683 

Pilocarpine, internally if vitreous becomes 
opaque, also in gonorrhoeal types, 6S3 

Salicylic acid or oil of gaultheria, followed 
later by potassium iodide, in rheumatic 
iritis, 683 

Saline laxatives, during course of disease, 
followed by iron, after cessation of spe- 
cific treatment, 683 

Scopolamine in early stages of, and in 
plastic, 390 

Subconjunctival injections of sublimate or 
of salt solution recommended in syph- 
ilitic iritis, 683 

Turpentine accompanied by potassium 
iodide, in plastic iritis, following sec- 
ondary syphilis, 683 

Zollicoffer's mixture, useful in chronic 
types, 683 



IRRITABILITY. 

Almonds, as a drink in irritability of in- 
testines and air-passages, 68 

Cantharis, recommended in irritable blad- 
der of women and children, 138 

Cimicifuga, in uterine irritability, 178 

Hops, in vesical irritability, 251 

Hydrocyanic acid, in irritability of the 
stomach, 255 

Hyoscyamus, for vesical irritability with 
incontinence, 258 

Petrolatum, as a soothing agent in gastro- 
intestinal types, 355 

Piperazine, in bladder irritation due to ex- 
cess of uric acid, 367 

Potassium bromide, in irritability of phar- 
ynx, 117 

JAUNDICE. 
Calomel, gr. £ (0.01), every half-hour till 
gr. i (0.025) is taken, if due to cold, 308 
Carbolic acid, gr. 10 (0.65), with water and 
glycerin, each 2 drachms (8.0), locally 
applied in itching of jaundice, 143 
Citric acid, in catarrhal form, 186 
Hydrastis, useful in subacute types, 252 
Iodoform, highly recommended, 270 
Manganese sulphate, may be tried in ma- 
larial types, 296 
Pilocarpine, useful unless due to malignant 

disease, 365 
Salol, said to be of value, 385 
Sodium phosphate, of value, 358 

JOINTS (ENLARGED). 

Tartar emetic ointment, 85 
Turpentine liniment, 424 

KELOID. 

Ichthyol ointment, 260 
Thiosinamine, 10 per cent, solution in al- 
cohol, injected into the growth, 417 

KERATITIS (INTERSTITIAL), 684 

Antiseptic lotions, in marked ciliary con- 
gestion, 684 

Autisvphilitic treatment, if due to svph- 
ilis, 684 

Atropine, in ciliary congestion, to prevent 
iritis, 684 

Leeches, to temple to relieve pain, if pa- 
tient is not too young for bleeding, 684 

Thymol iodide, as a dusting-powder, 418 

KERATITIS (PHLYCTENULAR), 684 

Atropine, to relieve pain, 684 

Boric acid, solution, to relieve congestion, 
684 

Cocaine, not advisable in photophobia, 685 

Cold-water douche on closed eyelid, to re- 
lieve photophobia, 685 

Creolin, 208 

Dark glasses, to protect eyes. 685 

Tonics and alteratives, with strict hygiene 
and regulated diet, associated with local 
treatment, 685 

Yellow oxide of mercury ointment, or cal- 
omel as a dusting-powder, to hasten 
cicatrization, contraindicated if iodine 
is being given, 684 



840 



INDEX OF DISEASES AND REMEDIES. 



KERATITIS (ULCERATIVE), 685 

Antiseptic lotions, to limit sloughing, 686 
Atropine, instilled into eye, to limit 

sloughing, 686 
Cautery, actual, best means of preventing 

perforation, 6S6 
Curetting floor of ulcer, if perforation 

threatens, 686 
Hot compresses of carbolized water and 

atropine drops, 686 
Massage of cornea and introduction of 

yellow-oxide ointment to remove scars 

of ulcers, 687 
Pressure bandage, if perforation threatens, 

686 
Silver nitrate or tincture of iodine applied 

to margin of ulcer does good, 686 
Subconjunctival injections of salt solution 

to absorb corneal nebula, 687 

LACHRYMAL ABSCESS, 687 

Division of canaliculi and wasbing out sac 
with antiseptic fluids, and insertion of 
probes into ducts after inflammation 
subsides, to restore patulency, 687 

Formaldehyde (1 : 6000), silver nitrate 
(1 : 500), or protargol (2 to 5 per 100) in- 
jected through external opening if there 
is purulent discharge, 687 

Hot compresses, composed of lead-water 
and laudanum, to relieve pain, 687 

Puncture of abscess, if rupture threatens, 
687 

LARYNGISMUS STRIDULUS. 

Amvl nitrite, 80 
Belladonna, 108 
Bromide of potassium, 118 
Gelsemium, 240 

LARYNGITIS (ACUTE), 687 

Aconite, to control fever, 688 

Antipvrin, as a spray, 90 

Bromides, useful in full doses, 60 to 120 

grains (4.0-8.0) a day, 118, 688 
Calomel, small and repeated doses, fol- 
lowed by saline purges, along with hot 

mustard' foot-baths and demulcent 

drinks, 688 
Creosote spray in subacute laryngitis, 207 
Cabebs cigarettes, useful for hoarseness of 

subacute forms, 210 
Dover's powder, if necessary, to give rest, 

340 
Iodine, painted overtbroat, useful on third 

or fourth day, 688 
Mustard plaster or hot applications over 

larynx, 688 
Oil of amber and olive oil. half and half, 

well rubbed into the skin of the neck 

and chest, 73. 688 
Prescriptions Pot sprays, 688 

Silver nitrate 322 

Steam inhalations, charged with benzoin : 

often advantageous to add menthol, 

110, 683 



LEPRA. 



Arsenic, 07 



LEUCOCYTH.EMIA. 

Arsenic, very useful in full ascending 
doses, 96 

LEUCORRHGEA, 689 

Alum, gr. 10 to 20 to the ounce (0.65-1.3 : 
30.0), as a vaginal wash, 72 

Ammonio-ferric alum, gr. 2 to 5 (0.1-0.25), 
in atonic types, 275 

Belladonna, gr. 1 to 2 (0.05-0.1), with tan- 
nic acid, gr. 6 to 8 (0.5), applied on cot- 
ton, in disease of uterine cervix, 106 

Cantharidal collodion, applied over groins 
to produce blister, 690 

Goodell's prescription for, 690 

Hsematoxylon, used internallv, of service, 
247 

Hot sitz-bath, or vaginal injections of hot 
water, if due to uterine congestion, 474 

Hydrastis, injections, 252 

Iron, with tonics, if due to excessive lacta- 
tion or exhausting life, 689 

Myrrh, if due to uterine trouble, 317 

Nitrate of silver, when there is cervical 
ulceration, 322 

Potassium permanganate (drachm i [2.0] 
to water 1 pint [500.0]), as an injection, 
if discharge is fetid, 690 

Prescriptions for injection, 690, 691 

Einger's prescription for wash, 690 

Tampon, saturated with iodoform and tan- 
nic acid, 413, 690 

White-oak bark (ounce 1 [30.0] to water 1 
pint [500.0]), or tannic acid and glycerin 
(ounce 1 [30.0] to 2 quarts [2 litres] of 
water), as an injection, 375, 690 

LICHEN. 

Arsenic, usually cures, 97 
Cantharides, 138 

LID ABSCESSES, 691 
Treatment same as for other abscesses, 691 

LITH^MIA. (See Gout.) 
LOCOMOTOR ATAXIA. 

Acetanilid, 54 

Antipvrin, relieves lancinating pains, 89 

Co-ordinated movements in, 458 

Exalgine, prescriptions for, 236 

Phenacetin, 356 

Potassium bromide, to prevent laryngeal 

crises, 118 
Suspension, 503 

LUMBAGO, 691 

Acupuncture, often relieves, especially if 
pain is bilateral, 691 

Antifebrin, dose gr. 2 to 4 (0.1-0.2), 691 

Antipvrin. dose gr. 5 to 10 (0.35-0.65), (i!»l 

Chloroform liniment, 172 

Cod-liver oil, 196 

Foot-bath and Dover's powder, before re- 
tiring, often relieves, <>!>1 

Hot poultice to back often useful. 691 

[ce-bag or ether spray to loins, if hot ap- 

plications fail, 691 
Ironing back with laundry iron, skin being 
protected by cloth or paper, very effi- 
cient, 691 



INDEX OF DISEASES AND REMEDIES. 



841 



Monobromated camphor, with other drugs, 
very useful, 134 

Mustard or capsicum plaster or blister over 
painful spot may relieve, 691 

Phenacetin and salol, of each 5 grains (0.3), 
691 

Potassium iodide or salicylic acid, if recov- 
ery is slow, 262, 691 

Salicylic acid, useful, 381, 691 

Turpentine, gtt. 20 (1.3), said to be useful, 
423 

LUPUS. 

Acid nitrate of mercury, 312 
Europhen, in ointment or powder, 236 
Ichthyol ointment, 260 
Iodine, as a paint, to retard spread, 267 
Thiosinamine, useful in, 417 

MALARIAL FEVER. (See Intermittent 

AND EEMITTENT FEVERS. ) 

Antipyrin, 89 

Arsenic, as a cure and prophylactic, 96 

Calomel, 309 

Eucalyptus, instead of quinine, when it 

cannot be borne, 234 
Gelsemium, of doubtful value, 240 
Gentian, in malaria associated with dys- 
pepsia, 241 
Hvdrastis. said to be antimalarial, 252 
Methylene blue, 1 to 4 grains (0.05-0.2), 314 
Phenocoll, useful in some cases, 357 
Pilocarpine, may be used to abort, 365 
Piperin, has been used with varying suc- 
cess, 351 
Quinine, the best remedy as a prophylactic 

and a cure, 181, 182 
Warburg's tincture, said to excel quinine 
in pernicious malarial regions, 429 

MANIA (ACUTE), 691 

Anaesthetics, or apomorphine in emetic 
dose, to relax muscular system, if pa- 
tient is very violent, so that other rem- 
edies may be administered, 692 

Bromide of potassium, as a soporific, 118 

Cannabis indica, with large dose of bro- 
mides, particularly serviceable, 692 

Chloral, in full doses, if kidneys are 
healthy, 692 

Chloroform for insomnia, 168 

Cimicifuga, fluid extract, TT^ 20 to 30 (1.4- 
2.0) thrice daily, in cases occurring after 
confinement not due to permanent 
causes, 692 

Cold douche to head while body is im- 
mersed in hot water, often of service, 
692 

Duboisine, for insomnia, 218 

Hyoscine hydrobromate, gr. y^ (0.0006), 
when necessary to quiet patient quicklv, 
692 

Morphine, in full dose, may be required to 
quiet patient, 692 

Scopolamine as a soporific, 390 

Sulphonal as an hypnotic, 406 

MARASMUS. 

Cod-liver oil inunctions, one of the best 
remedies, 196 



MASTITIS. (See Breast, Inflamed.) 

MELANCHOLIA, 692 

Chloroform for insomnia, 168 
Nitro-muriatic acid, TT^ 5 (0.3), in water 

after meals, if associated with oxaluria, 

327, 692 
Phosphorus, useful in some cases due to 

overwork, 360 

MENINGITIS (ACUTE), 692 

Aconite or veratrum viride, in early stages 
to depress circulation, 693 

Alcohol, given with food in second stage, 
if there be asthenia, 693 

Belladonna, often useful, especially when 
opium and calomel are contraindicated, 
693 

Blister to nape of neck, in early stage, to 
prevent effusion ; also in comatose state, 
693 

Bromides and chloral, best agents to allay 
nervous symptoms, 693 

Calomel, gr. i (0.03), with opium, gr. i 
(0.016), every half-hour, in early stage, 
until effect is manifested ; the deodor- 
ized tincture, n^ 2 to 5 (0.1-0.25), every 
two hours, or less, preferable to powder 
of opium in some cases, 304, 693 

Ergot, in stage of exudation, 693 

Ice-bag to head, in early stage, 693 

Leeches to nape of neck, in early stage, 
693 

Milk diet, in second stage, 693 

Opium, useful in second stage, 340, 693 

Quinine, contraindicated in acute stage, 
693 

Venesection in early stage of sthenic cases, 
if aconite or veratrum viride is not at 
hand, 508, 693 

MENINGITIS (CHRONIC). 
Phosphorus, 360 

MENOPAUSE. 

Bromide of potassium, in nervous disor- 
ders, 117 

Cannabis indica, alone or with aloes and 
iron, if anaemia or constipation exist, in 
headaches of the menopause, 136 

Eau de Cologne, saturated with camphor, 
locally applied in headache or drowsi- 
ness, 133 

Ovarian extract, for nervous and nutri- 
tional disturbances, 345 

Valerianate of ammonium, in nervous dis- 
orders, 79 

MENORRHAGIA AND METRORRHAGIA, 
655 

Adrenalin chloride (1 : 5000) may be em- 
ployed, 656 

Bromide of potassium or sodium, gr. 10 
(0.65) once or twice daily, if bleeding is 
irregular, 118, 656 

Cannabis indica, recommended, 136, 656 

Cinnamon oil, drachm i (2.0), when erig- 
eron is not at hand, in oozing flow, 657 

Drv cups, over sacrum, if due to conges- 
tion, 657 



842 



INDEX OF DISEASES AND REMEDIES. 



Ergot, fluid extract, n^ 10 to 60 (0.65-4.0), 
best remedy in active bleeding, 222, 656 

Erigeron, oil of, minims 3 to 5 (0.15-0.3), 
in capsule or emulsion, the best remedy 
for oozing, 656 

Hamamelis, distilled extract, drachm 1 
(4.0) thrice daily, in irregular bleeding, 
656 

Mammary gland, 296 

Monsel's solution (50 per cent.) full strength 
locally applied, if due to polypus, 279 

Ehus aromatica, highly recommended iu 
menorrhagia, 377 

Eue, in atonic menorrhagia, 379 

Savine, oil of, TT^ 5 to 10 (0.3-0.65), in cap- 
sule or emulsion, every three or four 
hours, as a tonic in menorrhagia, 389 

Turpentine, often of value, 423 

MIGRAINE, 693 
Amyl nitrite, 80 
Bromide of potassium, with caffeine, almost 

a specific, if due to eye-strain, 118 
Cannabis indica, tincture, TT\ 20 (1.3) 

hourly, or extract, gr. i to | (0.016-0.03) 

every two hours, best treatment, 135, 

702 
Croton chloral, very efficient, especially if 

fifth nerve is involved, 208 
Gelsemium, with cannabis indica, to abort, 

240, 702 
Methylene blue, gr. 1 to 2 (0.06-0.1), in 

capsule, 315 
Phenacetin, 356 
Salicvlic acid, of great service in rheumatic 

types, 381 

MILK DEFICIENCY, 728 

Electricity, 728 

Treatment for intercurrent affection, if due 
to such cause, 728 

MORPHIOMANIA. (See Poisoning from 

Opium, Chronic.) 
Bromide of potassium, 118 
Phosphorus, of service in sequelae of mor- 
phiomania, 360 

MUCOUS MEMBRANE (DISEASES OF). 

Acacia, as a mucilaginous drink in irrita- 
tion and inflammation of upper air- 
passages, 51 

Bismuth, as an astringent, to inflamed 
membranes, 111 

Flaxseed, as a soothing demulcent, 237 

Glycerole of aloes, locally applied to fis- 
sures, valuable, 70 

Opium, suppositories, gr. j (0.016), useful 
in rectal inflammation, if not an acute 
catarrh, 340 

Pareira, useful in chronic genito-urinary 
inflammation, 351 

Terebene, useful in snbacnte and chronic 
genito-urinary inflammation, instead of 
sandalwood or copaiba. 414 

Zinc sulphate, weak solution, as an astrin- 
gent, 131 

MUSCJE VOLIT ANTES, 694 

Alteratives and correction of anomalies of 
refraction, 694 



MUSCULAR STIFFNESS. 

Hot laundry iron passed over part, skin 
being protected by layers of paper or 
cloth, often relieves, 473 

MYALGIA, 694 

Ammonium chloride, if due to cold or 
bruises, 694 

Camphor liniment, 133 

Chloroform liniment, 694 

Cimicifuga, fluid extract, Tt\, 20 to 1 drachm 
t (1.3-4.0), 694 

Clove oil, added to liniment, as a counter- 
irritant, 187 

Iodide of potassium or salicylates, if due to 
rheumatism, 694 

Iodine ointment, pure or diluted with lard, 
694 

Massage or good rubbing, very necessarv, 
694 

Potassium acetate or citrate, gr. 20 (1.3), 
may be tried, 694 

Poultices, hot as can be borne, 694 

Prescription for liniment, 694 

MYXEDEMA. 

Thyroid gland, or extract of, a specific for, 
420 

NASAL CATARRH (ATROPHIC |, 695 

Dobell's solution, as a cleansing wash ; car- 
bolic acid may be increased, or thymol 
and eucalyptus substituted for it, to re- 
lieve odor, 695 

Galvano-cautery, or strong silver nitrate 
solution, if ulcerations are present, 695 

Hydrogen peroxide, 695 

Ichthyol, useful, 695 

Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.5:30.0]), with potassium iodide 
sufficient to cause solution of the 
iodine, valuable locally applied, 696 

Listerine may be added to Dobell's solution 
to relieve odor, 695 

Potassium iodide internally, tonics and 
stimulants to mucous membrane, and 
attention to activity of skin, 696 

Potassium permanganate, useful ; painful 
if sensation is not entirely lost, 696 

Removal of necrosed bone, 696 

Silver nitrate and starch (gr. 1 to 10 [0.05- 
0.65] to drachms 2\ [10.0]), asan insuffla- 
tion powder, or solution (gr. 1 to 10 to 
the ounce [0.05-0.65:30.0]), better, in 
some cases, locally applied, 696 

NASAL CATARRH (CHRONIC), 696 

Arsenic, 97 

Camphor, 132 

Ferric alum (gr. 5 to the ounce [0.3 : 30.0]), 
useful, in spray, in later "Stage, 697 

Galvano-cautery or snare, to remove hyper- 
trophic tissue remaining after acute 
stage, 697 

Hydrastis, dilute solution or distilled ex- 
traci of hamamelis and water, equal 
parts, useful in spray, in acute stage, 
697 



INDEX OF DISEASES AND REMEDIES. 



843 



Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.6 : 30.0J), with potassium iodide 
sufficient to cause solution of the iodine, 
locally applied, 697 

Prescription for alkaline wash, 697 

NAUSEA. (See Vomiting.) 

Hoffmann's anodyne, when due to excessive 

use of tobacco, 249 
Hydrocyanic acid, dilute, rr\, 3 (0.18), in 

water, often useful, 255 
Lime-water, 130 

NEPHRITIS (ACUTE), 697 

Aconite, to depress circulation, 697 

Blisters contraindicated, 697 

Bromides or opium, given cautiously if 
aconite fails to quiet restlessness, 697 

Caffeine, in later stages, 698 

Cannabis indica, if hematuria is present, 
also to allay pain over kidneys, 136, 698 

Cantharides, \ to 1 minim (0.01-0.05) of 
tincture about fifth day, when kidneys 
are atonic, also if hematuria is present, 
137, 698 

Citrate of potassium and sweet spirit of 
nitre, to increase flow of urine, 698 

Cups or leeches over loins if urine is scanty, 
697 

Digitalis, with squill or calomel, gradually 
increased, followed by gin or compound 
spirit of juniper in later stages, 698 

Elaterium, to relieve dropsy, 698 

Flaxseed tea, as a demulcent, 237, 698 

Gallic acid and ergot to control excessive 
hematuria, 698 

Hot-air baths, useful to provoke sweat, 693 

Iron, if anaemia be present, also to decrease 
albuminuria, 698 

Juniper, to re-establish secretion, after in- 
flammation has subsided, 283, 698 

Milk diet, 698 

Pilocarpine hydrochlorate, gr. 5 V to \ 
(0.003-0.008), hypodermically, if uraemia 
threatens, repeated in fifteen minutes 
if no sweat appears, but guarded by 
strychnine, when the heart is weak, 
365, 698 

Potassium bitartrate, 113 

Sulphate of magnesium, ^ss (15.0), or calo- 
mel, to aid in elimination of toxic prod- 
ucts by bowel, 698 

Turkish bath, to aid in eliminating effete 
products, used with care, 475 

NEPHRITIS (CHRONIC), 698 

Basham's mixture for anaemia, 276, 700 
Bichloride and protiodide of mercurv, 312, 

699 
Cannabis indica, to allay pain over kidneys, 

also if hematuria is present, 136 
Cantharides, particularly useful if due to 

alcoholism, 137, 699 
Capsicum, to check albuminuria, 139 
Chloride of gold and sodium has been rec- 
ommended in interstitial forms, 244 
Chloride of iron if anaemia is present ; also 

to decrease albuminuria, 277, 700 
Digitalis and caffeine useful, 699 
Elaterium or jalap, to relieve dropsy, 699 



Juniper of value, 699 

Milk diet, 699 

Nitro-glycerin useful in ascending doses in 
chronic parenchymatous nephritis, 325, 
699 

Oxygen inhalations, 700 

Potassium acetate or bitartrate combined 
with digitalis, or the bitartrate combined 
with gin or compound infusion of juni- 
per, 113, 699 

Potassium iodide, gr. 5 (0.3), thrice daily, 
used with great care, 263 

Sodium iodide, of great value in many 



Squill, 400, 699 

Strontium lactate, for the relief of albu- 
minuria, 403 

Turkish and Russian baths, relieve dropsy 
by increasing action of skin, 699 

NERVOUSNESS. 

Bromides, 117 

Camphor, as a sedative, 132 

Hops, as a sedative, 251 

Lime salts, 129 

Musk, useful in nervous excitement and 
collapse ; only to be used through crisis, 
316 

Phosphorus, in nervous debility and ex- 
haustion, 360 

" Pill of three valerianates," highly recom- 
mended, 426 

Rest-cure very useful where nervousness is 
due to exhaustion, 496 

Strychnine, in functional nervous atony or 
depression, 333 

Suprarenal gland, 410 

Sumbul, prescription for, 409 

Sweet spirit of nitre, in nervous excitement 
of fever and other nervous states of in- 
fancy, 412 

Valerian, alone or with other drugs, 425 

NEURALGIA, 700 

Acetanilid, useful, especially with mono- 
bromated camphor, 54, 701 

Aconite ointment (gr. 2 to the drachm [0.1 : 
4.0]), or oleate of aconitine (gr. 2 [0.1] 
to sweet oil 100 minims [6.0] ), useful 
applied over painful spot, if limited in 
area, 60, 702 

Acupuncture, nerve-stretching, or neurec- 
tomy, necessary in some cases, 702 

Ammonium chloride, in ovarian neuralgia, 
78 

Amyl nitrite, inhalations, when due to 
anaemia, 702 

Antipyrin, very useful, especially in gout, 
rheumatism, or nervous depression, 89, 
701 

Belladonna, 106, 108 

Bromide of potassium with caffeine, almost 
a specific, 701 

Prescription for, 118, 701 

Camphor liniment, locally applied, to re- 
lieve pain, 133 

Chloralamide, 155 

Chloroform liniment, as a local anaesthetic, 
172 



844 



INDEX OF DISEASES AND REMEDIES. 



Ciniicifuga, especially useful in ovarian 
tvpes, 178 

Cod-liver oil, 196, 700 

Croton chloral, gr. 5 to 20 (0.3-1.3), in 5- 
grain pills, often effective in brow neu- 
ralgia, 208, 702 

Duquesnel's crystalline aconitine in obsti- 
nate forms, 60 

Freezing parts with ether or rhigolene 
spray or by small packages of ice and 
salt, 229, 702 

Gnaiacol used locally, of value in, 246 

Hydrocyanic acid, useful in intestinal neu- 
ralgia, 255 

Iodide of potassium, may be tried in rheu- 
matic neuralgia, 262 

Iron and arsenic, in antenna ; often neces- 
sary to associate with them bitter tonics 
and cod-liver oil, 700 

Kataphoresis, 492, 702 

Menthol, locally, 353 

Morphine, gr. fcto ± (0.013-0.016), injected 
into painful spot, if localized ; not ad- 
visable in chronic cases, 702 

Muriate of ammonium, useful in ovarian 
types, 78 

Mustard plaster, as a counter-irritant, 317 

Nux vomica or strychnine, if nerve is de- 
pressed by anaemia, 700 

Peppermint oil, locally applied on cloth 
over painful spot, 353 

Phenacetin, gr. 3 to 8 (0.18-0.5), very use- 
ful, prescription for, 356, 701 

Phenocoll, 357 

Phosphorus, if due to nervous exhaustion, 
360, 701 

Potassium iodide, 262 

Prescriptions containing antipyrin with 
bromides and caffeine, 701 

Quinine, if due to malaria, 182, 701 

Rest-cure very useful in exhausted patients, 
496 

Salol, if due to exposure, 385 

Specific remedies, if due to scrofulosis or 
syphilis, 701 

Turkish bath, may relieve if due to rheu- 
matism or gout, 475 

Veratrine ointment, locally applied over 
neuralgic nerve, 426 

NIGHT-SCREAMING. 

Bromide of potassium, 118 

NIGHT-SWEATS. 

Acetic acid, as a lotion, diluted one-half, 

56 
Agaricin, of doubtful value, 61 
Alum dissolved in water or alcohol, efficient 

application for sponging, 72 
Belladonna, best remedy, 106 
Camphoric acid, the best of all remedies, 

L34 
Ergot, 222 
Gallic acid, 238 
Pilocarpine, gr. fo (0.003), hypodermically, 

two boms before sweat, often useful, 

even wben atropine fails, •><i6 
Sulphuric acid, with belladonna or mor- 
phine, often useful, 109 
Zinc oxide, prescription for, -'>\7 



NIPPLES (SORE), 702 

Benzoin, tincture, locally applied. 703 

Boric acid (gr. 20 to the ounce [1.3 : 30.0]), 
or mucilage of acacia, applied after 
nursing, nipple being dried beforehand, 
703 

Breast-pump or nipple-shield may be neces- 
sary to effect cure, 703 

Cocaine (gr. 4 to the ounce [0.2: 30.0]), ap- 
plied and washed off before nursing, if 
breast is very painful, 189, 702 

Iehthyol, when indurated, 260 

Prophylaxis, 703 

Silver-nitrate stick touched to fissure, if 
deep and slow to heal, 703 

Tannin, glycerite of, locally applied, 703 

NYMPHOMANIA. 

Bromide of potassium, of great service, 117 

OBESITY, 703 

Acetic acid, harmful, 56 

Cold bath, 706 

Diet, 705 

Laxative fruits and purges, to regulate 
bowels, 706 

Massage, passive movements, absolute 
skimmed-milk diet, and electricity, if 
exercise is impracticable, 706 

Potassium permanganate, 354 

Saline purges, 706 

Thyroid gland, 420 

Turkish bath, 706 

OPHTHALMIA. (See Conjunctivitis.) 

OPIUM HABIT. (See Poisoning from 
Opium, Chronic.) 

ORCHITIS, (See Epididymitis.) 

OSTEOMALACIA. 
Phosphorus, 360 

OTORRHGEA. 

Creolin, solution (1:500), used with 
syringe, 208 

OXALURIA. 

Nitric acid, 323 
Nitro-hydrochloric acid, 327 

OZ^NA. 

Prescription for insufflation powder, 305 

PARALYSIS AGITANS. 
Cannabis indica, to quiet tremors, 136 
Chloral, of great service, 154 
Duboisine sulphate, of some use, 219 
Sparteine, 391 

PARASITES. 

Bichloride of mercury (gr. 2 [0.1] to water 
oz. 1 [30.0]), applied thrice daily in para- 
sitic skin diseases, 306 

Cajuput oil, applied pure, will destroy pe- 
diculi, 127 

Chrysa robin, gr. i (Q.008), internally, or the 
ointment, with ben/.oated lard (1 : 4 or 
5), locally applied, in parasitic skin dis- 
eases ; must not be used on face, 177 



INDEX OF DISEASES AND REMEDIES. 



845 



Hyposulphite of sodium, 1 drachm to the 
ounce (4.0 : 30.0), for parasite skin dis- 
ease, 398 

Mercurial ointment, useful to destroy pe- 
diculus pubis or other parasites, 311 

Oil of cloves, 187 

Pyrogallol, 30 grains to the ounce (2.0 : 30.0), 
for parasitic skin disease or psoriasis, 
374 

Volatile or fixed oils, useful to destroy, 311 

PARTURITION. 

Antipyrin for pains, of doubtful value, 89 
Castor oil, to relieve constipation, 147 
Cimicifuga, 178 
Quinine, as a stimulant to uterus, 182 



PEMPHIGUS. 



Arsenic, 97 



PERICARDITIS, 706 

Aconite, to allay inflammation and quiet 
heart, 59, 706 

Alcohol, digitalis, or caffeine, if heart shows 
signs of failure, 706 

Aspiration, gradual, if exudation endangers 
life, 706 

Blister, over prsecordium, often useful, 706 

Calomel, gr. \ (0.03), with opium, hourly, 
to prevent exudation, 706' 

Elaterium, useful in effusions, 219 

Ice-bag over the prsecordium, very useful, 
706 

Iodide of potassium, to aid in absorption 
of fluid, 262 

Jalap, compound powder of, gr. 20 (1.3) ; or 
elaterium, gr. \ (0.01) ; or saline purga- 
tive, before breakfast, useful in sthenic 
cases, to remove effusion, 707 

Leeches, 5 to 10, over prsecordium, accom- 
panied by large dose of veratrum viride 
in early stages of sthenic cases, 706 

Opium, to allay inflammation, 340 

PERITONITIS (ACUTE), 707 

Acetanilid, 710 

Calomel, \ gr. (0.03) every hour, preferably 
combined with opium, 304, 710 

Hyoscyamus, by suppository or injection, in 
collapse, 710 

Ice, with white of egg, for thirst. Vomit- 
ing does not contraindicate small 
amounts of water, 710 

Ice-bag or turpentine stupe to abdomen ; 
leeches in sthenic cases, 710 

Opium, pushed until pain is relieved, but 
never to the point of obtunding intelli- 
gence, 340, 709 

Rectal tube, milk of asafcetida or turpen- 
tine injections, in tympanites, 710 

Salines, useful in cases following surgical 
operations, but contraindicated by fee- 
bleness, perforation, or obstruction, 710 

Surgical procedures, often necessary. When 
diagnosis is obscure or in septic general 
peritonitis exploratory incision is justi- 
fied, 710 

Veratrum viride, 428 



PERITONITIS (CHRONIC), 711 

Incision, with or without drainage and 
iodoform, useful in tubercular peri- 
tonitis, 711 

PERNICIOUS MALARIAL FEVER, 711 

Hyposulphite of sodium, grs. 60 (4.0) to 

move the bowels, 711 
Morphine and atropine to control retching 

and vomiting, 711 
Quinine, large doses, in solution, by mouth, 
' rectum, or hypodermically, 182, 711 

PHARYNGITIS. 

Antipyrin in 4 per cent, spray, 90 

Cocaine, gives temporary relief; after- 
effects bad, 189 

Cubebs, troches of, used in chronic types, 
210 

Monsel's solution, pure or diluted one-half 
with glycerin, applied on pledgets of 
cotton or camel's-hair brush, 279 

Peroxide of hydrogen, 256 

Salol, in 5-gr. (0.3) doses, 285 

Silver nitrate solution, in varying strength, 
locally applied, 322 

Turkish bath, in acute forms, when phar- 
ynx feels raw, 475 

PHTHISIS. (See Tubekculosis.) 

PLEURITIS, or PLEURISY, 712 

Aconite or veratrum viride, preferable to 
venesection, in early stage, 712 

Aspiration, when hydragogue purges fail to 
remove effusion, 713 

Calomel, in sthenic cases to prevent exuda- 
tion, 304 

Cantharidal blister,two inches below axilla, 
aids absorption of effusion, 462, 714 

Cotton jacket, 713 

Digitalis or alcohol, if pulse weakens in 
second stage, 713 

Elaterium or jalap, useful to remove effu- 
sion, 219, 713 

Gelsemium, 240 

Ice-poultice or jacket, used with success in 
sthenic cases, 444 

Iodide of potassium, used in chronic stage, 
to aid absorption, 262 

Iodine, locally applied, to abort, and aid 
absorption of fluid, 267 

Pilocarpine, 365 

Salicylates, very useful for the removal of 
effusion, 382, 713 

Saline purges, in second stage, to remove 
effusion, 713 

Strapping chest, if respiratory movements 
are very painful, 712 

Veratrum viride, 428 

PLEURODYNIA. (See Neuralgia.) 
PNEUMONIA, 714 

Aconite, preferable to veratrum viride, in 
early stage, in children, 715 

Alcohol, inferior to digitalis, as a cardiac 
stimulant in the second stage in adults, 
but better than in children, 63. 717 



846 



INDEX OF DISEASES AND REMEDIES. 



Ammonia useful for adults and children, 
717 

Ammonium bromide and carbonate may be 
used if the chloride fails, 719 

Ammonium chloride, as an expectorant in 
• third stage, 718 

Antipyrin, of great value, if fever is exces- 
sive, 88 

Belladonna, very useful, if there are evi- 
dences of collapse, 108, 717 

Citrate of potassium, to maintain renal 
activity, 718 

Cold sponging for fever, 716 

Digitalis, tincture, TT^ 5 (0.3), every four 
hours, accompanied by belladonna, gtt. 
5 (0.3), carefully watched in second 
stage, 717 

Dover's powder for pain at onset, 715 

Ethyl iodide, causes resolution, 232 

Gelsemium, in early stages, 240 

Gin, to maintain renal activity, 718 

Hoffmann's anodyne, useful, 717 

Hot foot-bath, useful at onset, 715 

Ice-bag to heart if fever be high and heart 
tumultuous, 716 

Ice-poultice or jacket, highly recommended 
in first stage of sthenic cases, 444, 716 

Iodide of potassium, in later stages to ab- 
sorb exudates, 263 

Morphine, for pain at onset, and for exces- 
sive cough, 717, 718 

Nitroglycerin, in high arterial tension 
with thickened arteries, 717 

Oxvjjen inhalations, if asphyxia threatens, 
317, 717 

Phosphorus, 360 

Prescriptions, containing ammonium chlo- 
ride, to loosen cough of second stage, 
718 

Quinine, gr. 2 (0.1) thrice daily, in sup- 
positorv in lobar pneumonia of children, 
182 

Strychnine as a respiratory and circulatory 
stimulant in second stage and as an ad- 
juvant to digitalis, 333, 717 

Sweet spirits of nitre to maintain renal ac- 
tivity, 718 

Venesection, in early stage of sthenic cases, 
cardiac depressants preferable, and late 
when heart is laboring and veins dis- 
tended, 508, 715, 717 

Veratrum viride, preferable to aconite, in 
early stage, in adults, 428, 715 

POISONING FROM— 

Acetanilid. 

Supportive measures, stimulants, external 
heat, belladonna to maintain blood- 
pressure, strychnine to counteract res- 
piratory failure, and oxygen inhala- 
tions to overcome cyanosis, 54 

Acetate of Zinc. 

Treatment same as for gastro-enteritis, 632 

Acetic Acid. 

Large amounts of milk, alkaline liquids, 
and general treatment for gastro-enteri- ! 
tis, 57 



Aconite. 
Keen patient in prone position, with feet 
higher than head. Hot applications; 
emetics contraindicated; evacuate stom- 
ach by siphon or stomach-pump. Ether 
hypodermically, followed by alcohol, 
and this by digitalis. Artificial respira- 
tion and amyl nitrite a few whiffs, no 
more, if heart fails ; atropine, strych- 
nine, 58 

Alcohol (Acute). 

External heat, digitalis and strychnine 
hypodermically, in coma, if heart fails. 
Belladonna, if the skin is relaxed and 
clammy, and counter-irritation to nape 
of neck, for brain symptoms. After- 
treatment, ammonia, spices, spirit of 
Mindererus; emollients in gastritis, ice, 
aconite, hydrochloric acid, or ipecac in 
minute dose, and counter-irritation for 
vomiting. Jalap, gr. 40 (2.6). elaterium, 
gr. £ (0.011), or calomel and salines, as 
purgatives, 64 

Fowler's solution for morning vomiting, 97 

Alcohol (Chronic). 
Withdrawal of drug, at once or gradually. 
Highly seasoned broths, predigested 
food, and morphine or coca, in small 
dose, if weakness is marked. Capsicum 
prescriptions (pages 65, 139), 65 

Antimony. 

Large doses of tannic acid, external heat, 
alcohol, digitalis, and opium hypoder- 
mically, if respiration is not too feeble. 
If necessary to use opium, it should be 
accompanied by strychnine. Prone po- 
sition, the patient vomiting into towels. 
Stomach-pump, if vomiting is absent, 
84 ; atropine, 109 

Antipyrin. 
Maintain bodily heat, stimulants, atropine, 
and oxygen inhalations, if cyanosis is 
alarming, 88 

Arsenic (Acute and Chronic). 

Stomach-pump, external heat, stimulants, 
and the chemical antidote, hydrated 
scsquioxide of iron and magnesia. Mag- 
nesia also useful by itself. Opium should 
follow antidote, to allay pain, also large. 
draughts of water to flush kidneys and 
dilute poison. For chronic poisoning, 
iodide of potassium, tonics, electricity, 
and out-of-door life, 99, 100 

Belladonna. 
External heat if collapse intervene, and 
strychnine to support respiration. The 
physiological antidote, opium, may be 
carefully given, 107 

Carbolic Acid. 
Soluble sulphates, as Epsom or Glauber 

salts, warm mucilaginous drinks, hot 
applications to extremities, digitalis, 
strychnine, and counter-irritation over 
abdomen. Emetics and stomach-pump 
should be used if possible, 142 



INDEX OF DISEASES AND REMEDIES. 



847 



Chloral. 

External heat, emetics in early and stom- 
ach-pump in later stages. Strychnine 
or atropine to stimulate respiration. 
Digitalis, preceded by ether, ammonia, 
brandy, or whiskey. Prone position, 
feet being elevated, 153 

Chloroform. 

Artificial respiration, ether and hot brandy 
hypodermically. Poles of battery with 
rapidly interrupted current swept over 
body, not over diaphragm or phrenic 
nerve. Place patient with head down- 
ward. Compression of the abdomen 
and limbs ; compression and massage of 
the prcecordium. Atropine, strychnine, 
and digitalis to stimulate the heart and 
respiration. Laborde's lingual traction, 
172 

Cocaine. 

Ammonia, coffee, strychnine, ether, and 
alcohol. If convulsive in type, treat 
same as strychnine poisoning, 193 

Colchicum. 

Tannic acid, emetics, and stomach-pump. 
Opium to relieve pain, and oils. Atro- 
pine and stimulants if collapse comes 
on, 198 

Conium. 

Emetics or stomach-pump, strychnine as a 
nervous and respiratory stimulant, ex- 
ternal heat and cardiac stimulants, if 
circulation fails, 202 

Copper. 

Yellow prussiate of potassium, sweet oil, 
white of egg ; followed instantly by 
emetics or stomach-pump. If emesis or 
purgation is present, emetics are contra- 
indicated ; instead, mustard plaster over 
abdomen and opium, internally, are to 
be employed, 204 

Corrosive Sublimate. 

Large amounts of white of egg, followed 
by stomach-pump, external heat, stimu- 
lants, 305 

Croton Oil. 

Treatment same as for gastro-enteritis, 632 

Digitalis. 
Tannic acid as a chemical antidote, emetics 
or stomach-pump, external heat to ab- 
domen and aconite as a physiological 
antidote. Maintain horizontal position, 
215 

Elaterium. 
Treatment same as for gastro-enteritis, 632 

Ether. 

Artificial respiration, lowering head if face 
is pale ; strychnine, atropine, and digi- 
talis hypodermically, or intravenous in- 
jection of ammonia to stimulate heart 
and respiration ; frictions and hot ap- 



plications; ether dashed on chest and 
abdomen ; Laborde's method of traction 
of the tongue, 226 

Eucaine. 

Treatment like that of cocaine intoxica- 
tion, 193 

Gelsemium. 

Emetics and stomach-pump, digitalis, atro- 
pine, and ammonia as cardiac stimu- 
lants ; external heat, strychnine, and 
atropine for respiratory centre, 240 

Iodine. 

Emetics or stomach-pump, large amounts 
of starch, hot applications, and hypo- 
dermic injections of alcohol, ammonia, 
atropine, digitalis, or strychnine, 265 

Iodoform. 

Sodium bicarbonate to combine with iodine, 
alcohol, diuretics, and hot blankets ; 
saline transfusion, 269 

Lead (Acute). 

Epsom or Glauber salts, in large amounts; 
alum ; emetics or stomach-pump. Hot 
applications and opium to relieve pain, 
285 

Lead (Chronic). 

Jalap and calomel with opium or alum, 
gr. 2 (0.1), in full dose, valuable in lead 
colic. Blister to back of neck, revulsives 
and pilocarpine in cerebral inflamma- 
tion. Iodide of potassium to eliminate 
lead. Strychnine in progressive paral- 
ysis. Electricity and baths of sulphuret 
of potassium, 285 

Mineral Acids. 

Alkalies, such as magnesium, lime, white- 
wash, and soap as antidotes ; white of 
egg, external heat, oils and opium, to 
relieve irritation. 

Monsel's Solution. 

Soap, 297 

Nitrate of Silver (Acute). 
Common salt as the chemical antidote, 
opium and oils to allay irritation ; also 
large amounts of milk and soap and 
water ; maintain bodily heat, 320 

Nitrate of Silver (Chronic). 
Iodide of potassium, to aid in eliminating 
poison, 320 

Nux Vomica and its Alkaloids. 
Inhalations of amyl nitrite, to prevent con- 
vulsive tendencies ; at the same time use 
stomach-pump. Tannic acid followed 
by physiological antidotes, potassium 
bromide, gr. 60 (2.0), with chloral, gr. 
20 (1.3). If convulsions prevent swal- 
lowing, chloroform patient carefully 
and give antidotes by rectum in starch- 
water. Amyl nitrite, hypodermically, 
if relaxation does not occur, 331 



848 



INDEX OF DISEASES AND REMEDIES. 



Opium (Acute). 
Emetics, or stomach-pump, tannic acid, 
black coffee, electricity, and other meas- 
ures to keep patient awake. Atropine 
or strychnine, hypodermically, if respi- 
ration fails. Alcohol, ammonia, and 
external heat. Artificial respiration 
may be necessary; repeated washing 
out of stomach. Permanganate of po- 
tassium, 337 

Opium (Chronic). 
Decrease a sixth or fourth of customary 
amount each twenty-four hours. Co- 
caine not advisable as a substitute, as 
the cocaine-habit may be established. 
Digitalis and strychnine if heart fails, 
338 

Phosphorus. 

Permanganate of potassium, 1 per cent, so- 
lution, or peroxide of hydrogen. Sul- 
phate of copper is too poisonous in itself, 
360 

Physostigma. 
Atropine as a physiological antidote, ex- 
ternal heat, and cardiac and respiratory 
stimulants, 362 

Scammony. 

Treatment same as for gastro-enteritis, 632 

Strychnine. (See Nux Vomica.) 

Veratrum Viride. 
Prone position, head higher than feet ; 
atropine, strychnine, external heat, and 
cardiac stimulants, 427 

POST-PARTUM HEMORRHAGE, 661, 726 
Adrenalin chloride, 661 
Auto-transfusion, or actual transfusion of 

weak salt solution, necessary in some 

cases, 728 
Beef-tea, \ pint (250.0), and morphine gr. £ 

(0.01) hypodermically, after reaction is 

established, 728 
Correction of displacement sometimes nec- 
essary, 726 
Drugs have been recommended, but are 

dangerous as local applications, 727 
Enema, of hot water, 1 pint (500.0), after 

cessation of bleeding, 727 
Ergot, as a cure and prophylactic, 221, 661 
Ether, hypodermically, if symptoms of 

shock arc manifested, followed by small 

doses of hot, strong brandy and water, 

and warm milk, 727 
Gauze, preferably iodoform, packed into 

uterine cavity. 727 
I<c. used externally and internally, 727 
Injections of lemon-juice, vinegar, or hot 

water, 661, 72? 
Manipulations of the uterus, 661, 727 
Method to pursue when caused by hsema- 

boma, 726 
Snt nre, if due to laceration, 727 



PRIAPISM. 



Hops, 251 



PROLAPSUS ANI AND RECTI. 

Injection of cold or hot water, often re- 
lieves, 447 
Quercus alba, infusion, 375 

PROSTATITIS, 639 

Cold-water injections and perineal douches, 
448, 640 

Local treatment to prostatic urethra, and 
use of cold steel sounds in chronic 
types, 640 

Perineal incision, to evacuate pus, if ab- 
scess forms, 640 

Eest in bed, regulation of bowels, leeches 
to perineum, medication to render urine 
alkaline, and morphine hypodermically 
or in suppository. 639 

Soft catheter, allowed to remain in blad- 
der, if retention of urine is persistent, 
640 

PROSTATORRHCEA. 

Cantharides, 138 

PRURIGO. 

Cantharides, 138 

PRURITUS, 719 

Alum solution in pruritus vulvas, 72 

Arsenic, quinine, bitter tonics, cod-liver 
oil, alkaline diuretics or mineral waters, 
in debility, and avoidance of condi- 
ments if mouth of vagina or urethra is 
affected, 719 

Boric acid, 113 

Calomel and lard (1 drachm to the ounce 
[4.0 : 30.0]), locally applied, 310 

Carbolic acid, 720 

Chloride of calcium, prescription for, 128 

Chloroform may be used, 720 

Cocaine, relieves temporarily, 720 

Cold douche and injections highly recom- 
mended in pruritus ani and vulvae, 448 

Goulard's extract, dilute, useful in pruritus 
pudendi, 289 

Hydrocyanic acid, locally applied, 255 

Ivory plug for, 720 

Prescriptions for lotions and ointments, 
720 

Salicylic acid, prescription for, 382 

Silver nitrate (gr. 20 to the ounce [1.3 : 
30.0]), locally applied, preceded by co- 
caine, if itching is intense ; a 4- to 6- 
grain (0.2-0.3) solution may relieve 
itching of pruritus pudendi, ani and 
vulvas, 322, 720 

Sodium bicarbonate or borax (1 drachm to 
the pint [4.0 : 500.0]), as a wash, 720 

Teucrium scordium, highly recommended 
by Brinton, 720 

Turkish baths, 720 

PSEUDO-LEUKEMIA. 

Arsenic internally, and injections of Fow- 
ler's solution into glands, 97 

PSORIASIS. 

Amnion iated mercury in, 305 
Anthrarobin, 81 
Aristol, 418 



INDEX OF DISEASES AND REMEDIES. 



849 



Arsenic, 97 

Cantharides, 138 

Chrysarobin, gr. \ (0.008) internally, or the 

ointment with benzoated lard (1 to 4 

or 5), locally applied, face excepted ; 

prescription for application, 177 
Gallic acid, ointment, 238 
Pyrogallol, 30 grains to ounce (2.0 : 30.0) 

of lard, 374 
Eesorciu, prescription for, 375 
Tar, locally applied, 369 
Thymol iodide, 418 
Thyroid gland in, 420 

PTYALISM. 

Alum, applied on swab, in mercurial ptyal- 

ism, 72 
Belladonna, in idiopathic or mercurial 

types, 106 

PUERPERAL DISEASES, 721 

(For treatment see special titles.) 

PUERPERAL FEVER, 721 

Antipyretics, best abstained from as long as 
possible, 722 

Antistreptococcic serum, nuclein, and injec- 
tions of normal salt solution important 
adjuvants, 722 

Bichloride of mercury (1 : 2000), or creolin 
(2 per cent.) solutions, as antiseptic in- 
jections, 721 

Boric acid, creolin (2 per cent.), or bichlo- 
ride (1 : 8000), solutions, as injections 
into bladder, to prevent septic cystitis, 
724 

Curette or placental forceps, to remove 
membranes if fever continues after an- 
tiseptic injections, 722 

Epsom salts, concentrated solution, 2 
drachms (8.0) every fifteen minutes, if 
peritonitis develops, 723 

Laparotomy occasionally saves life, if sep- 
tic peritonitis develops, 722 

Nutriment in large amounts and alcoholic 
stimulants, if symptoms of systemic in- 
vasion arise, 724 

Silver nitrate (gr. 40 to 60 to the ounce 
[2.65-4.0 : 30.0] ), locally applied to un- 
healthy ulcerated wounds; zinc chlo- 
ride solution may be necessary, 723 

Veratrum viride, 428 

PURPURA HEMORRHAGICA. 

Turpentine, 423 

PYELITIS. 

Buchu in chronic types, 123 

Cantharides, 138 

Copaiba, 203 

Juniper, as a tonic in chronic types, 283 

Pariera, 351 

Uva ursi, 425 

QUINSY. 

Aconite, in early stage, 59 

Salicylic acid, gr. 3 (0.15), hourly, acts as a 
specific, especially if due to rheuma- 
tism, 382 

54 



REMITTENT FEVER, 731 

Antipyrin, or cold pack, if fever is exces- 
sive, 732 

Eupatorium, 235 

Monsel's salt, gallic or tannic acid inter- 
nally, if intestinal hemorrhage occurs, 
732 

Morphine, spirit of chloroform, or aconite, 
in sthenic cases, to control vomiting, 
732 

Phenocoll, 5 to 8 grains (0.3-06), 357 

Quinine, gr. 20 to 30 (1.3-2.0), preceded by 
calomel, gr. 3 to 4 (0.15-0.2) ; if not re- 
tained, administer by rectum, or hypo- 
dermically, with divided doses of Seid- 
litz powder by mouth, 181, 732 

Tonics, potassium salts, to regulate kid- 
neys, and purgatives, if necessary, dur- 
ing convalescence, 732 

Turpentine stupe, if belly is tender, 732 

RETINITIS, 732 
Atropine, dark glasses, and later suitable 
lenses, if due to eye-strain, 733 

RHEUMATISM, ACUTE (ARTICULAR), 733 

Acetanilid, relieves pain and fever, 54, 
734 

Acetate of potassium, 56 

Aconite, or veratrum viride, useful at onset 
of inflammation in sthenic cases, 733 

Aspirin in acute cases, 102 

Alcohol, in depression, 733 

Ammonium bromide and phosphate, 77 

Antimonial powder as an antipyretic, 85 

Antipyrin, gr. 5 to 10 (0.3-0.65), or anti- 
febrin, gr. 4 to 8 (0.2-0.6), often yery 
valuable, 89, 735 

Benzoic acid, drachms 2 to 3 (8.0-12.0), 
daily, said to be a specific, 110 

Bicarbonate or citrate of potassium, gr. 20 
to 30 (1.3-2.0), in water, every five 
hours, in obstinate cases, 735, 737 

Bicarbonate of sodium, 397, 734 

Blisters over joints, useful after systemic 
disturbance is past, 737 

Caffeine useful to support the heart, 736 

Camphor liniment, 133 

Capsicum plaster, 140 

Cimicifuga, shortens attack and relieves 
pain in some cases, 178, 737 

Colchicum, prescription for, 737 

Cold pack, if fever threatens life, 734 

Fuller's lotion, applied on hot cloths to 
joints, 734 

Guaiac, 245 

Ice-cold compress, may relieve inflamed 
joints, 734 

Ichthyol, ointment, valuable, applied to 
joints, prescription for, 260, 734 

Iodine, ointment or tincture, painted over 
parts, 737 

Lemon or lime-juice, or citric acid, bene- 
ficial in nearly all cases, 186, 737 

Oil of gaultheria, useful as a substitute for 
salicylic aid ; also used as a local ap- 
plication to the joints. 239, 735 

01. succini, applied locally over joints. 73 

Phenacetin, alone or with salol, 357, 736 

Phenocoll, 357 : 



850 



INDEX OF DISEASES AND REMEDIES. 



Potassium iodide, useful iu subacute or ob- 
stinate types, prescription, 262, 736 

Potassium nitrate, 319 

Ehus toxicodendron, especially useful for 
nigbt pains, 737 

Salicylic acid, gr. 20 (1.3) thrice daily ; if 
untoward symptoms arise, it must be 
stopped, 381, 734, 735 

Salicylic acid, applied to joints in a salve 
when stomach is irritable, 382, 734 

Salol, useful as a substitute for salicylic 
acid ; dangerous in large doses, 385 

Sodium bicarbonate {gr. 20 to the ounce 
[1.3: 30.0]), to inflamed joints, 734 

Splints for fixation of limbs, may relieve 
greatly, 734 

Veratrine ointment, used locally, applied 
to joints, 737 

RHEUMATISM (CHRONIC), 738 

Arsenic, useful in some cases, 97 

Cimicifuga, sometimes relieves, 178 

Citric acid, 186 

Cod-liver oil, internally ; also useful rubbed 
into joints, 195, 738 

Colchicum, with iodide of potassium, pre- 
scription for, 198 

Hot-air bath, 475 

Ichthyol, the best remedy for joints, 739 

Iodine, locally applied, 267, 739 

Liniments, prescriptions for, 739 

Ointments, prescriptions for, 739 

Potassium iodide, colchicum, and sarsapa- 
rilla, usually indicated ; see prescrip- 
tions, 262, 738 

Salophen, 386 

Sulphur, 407 

Turkish or Eussian baths, very valuable, 
475, 738 

Yeratrine ointment, gives greatest relief 
in some cases, prescription for, 426, 739 

RHEUMATISM (MUSCULAR). 

Burgundy pitch, a mild local remedy, 368 

Croton oil liniment, 209 

Dover's powder in conjunction with hot 

drinks and hot foot-bath, often cures, 

341 
Mustard, as a counter-irritant, 317 
Veratrine ointment, locally applied, 426 

RHINITIS. 
Creolin (1: 1000), as a nasal douche, 208 
Fluid cosmoline, in spray, 355 
Potassium permanganate, solution, in foetid 
rhinitis, 355 

RHUS POISONING. 
Grindelia, 245 

Infusion of lobelia, 293 

Lead acetate. 288 

Liquor plumbi subacetatis, 289 

RICKETS, 740 
Arsenite of copper, 740 
Cinchona, or strychnine, 740 

Cod-liver oil, prescription for, 196, 710 
Cool sponging or rubbing witb salt and 

whiskey (] drachm to the pint [4.0: 
500.0]), useful at night, 740 



Hypophosphites and lactophosphates use- 
ful, 129 

Iodide of iron, syrup of, if scrofulous tend- 
ency or anaemia exists, prescriptions for, 
740 

Lime salts, phosphorus, zinc phosphide, as 
bone tonics, 740 

Massage and passive movements, 741 

Mineral acids, physostigina and simple 
bitters, as digestive tonics, 740 

Nux vomica, rarely given because of bit- 
terness, 740 

Phosphorus (gr. T foj [0.0006]), in sugar- 
coated pill, 360, 741 

Quinine, cod-liver oil, nux vomica, and 
iron as general tonics, 740 

Sodium and lime salts, useful in nursing 
and pregnant women, 741 

RINGWORM. (See Tinea Circinata.) 

SATYRIASIS. 

Potassium bromide, one of the best rem- 
edies, 1.17 

SCABIES. 

Sulphur, the best remedy, 408 

SCARLET FEVER, 741 

Aconite, harmful if constantly employed, 
60 

Alcohol, indicated in collapse, 743 

Antip3 T rin or acetanilid, may produce col- 
lapse in large doses, 89, 743 

Antistreptococcic serum, 441 

Bromide of sodium, with chloral, useful 
when convulsion ushers in attack, 742 

Carbolic acid (TT\, 2 [0.1] to olive oil oz. 2 
[60.0]), benzoated lard, vaseline, cosmo- 
line, or almond oil, useful, locally ap- 
plied, to allay itching, 744 

Chloral, very useful, prescription for, 742 

Chlorate of potassium, locally applied by 
spray or swab, in sore throat, 743 

Cold sponging, useful, 743 

Ice applied externally and held in mouth, 
to prevent swelling of throat, 743 

Ice-bag or rubber head -coil to head, if very 
hot, 743 

Juniper, in later stages, if there is renal 
atony, 283 

Potassium citrate and sweet spirit of nitre, 
prescription for, 742 

Quinine, unsuccessful in most cases, 743 

Salicylic acid, highly recommended, pre- 
scription for, 742 

Strychnine, iron, simple bitters, quinine or 
Basham's mixture, in convalescence, 
744 

Sweating necessary in nephritis, 744 

Warm wet pack, useful to bring out rash, 
743 

Water, pure, such as Vichy or Poland, in 
large amounts, 742 

SCIATICA, 744 

Absolute rest of limb in splints very need- 
ful, 715 

Acetanilid and antipyrin, 54, 715 
Acupuncture, recommended, 745 



INDEX OF DISEASES AND REMEDIES. 



851 



Cod-liver oil, of service in obstinate cases, 

196, 745 
Chloroform, deeply injected over exit of 

nerve, a favorite remedy, 172, 745 
Ether or rhigolene sprayed on part, often 

effective, 745 
Hot-water bags, placed around exit of 

sciatic nerve, 745 
Liniments for rheumatism, may be tried, 

744 
Massage of nerve with glass rod, 745 
Morphine, injected over course of nerve, 

745 
Nerve-stretching, 745 
Potassium bitartrate or citrate, gr. 40 (2.6) 

thrice daily, in plenty of water, to reg- 
ulate kidneys, 745 
Potassium iodide, 262 
Eemedies for rheumatism, often relieve, 

744 
Salicylic acid, 381 
Sulphur, 407 
Wet or dry cups, highly beneficial over 

course of nerve, 745 

SCLERITIS, 745 

Atropine, boric acid, and hot-water com- 
presses, in early stages, 745 

Eserine, with pilocarpine sweats or cautery, 
in stubborn episcleritis without iritis, 
745 

Specific treatment, in syphilitic cases, 745 

Yellow-oxide ointment, associated with 
massage to subdue infiltration, 745 

SCLEROSIS. 

Antipyrin, 89 
Nitrate of silver, 321 

SCROFULOSIS, 746 

Arsenic or corrosive sublimate, useful if 
anaemia is present, prescriptions for, 746 

Calcium chloride, 128, 129 

Cod-liver oil, the best remedy, 195, 746 

Diet and exercise, 746 

Europhen in scrofuloderm, 236 

Excision, or scraping gland, and packing 
with iodoform gauze if other treatment 
fail, 747 

Hypophosphite of calcium, 129 

Ichthyol ointment, useful, rubbed into per- 
sistent enlargements, prescription for, 
746 

Iodine ointment and lard, equal parts, 
rubbed into glands, stopping at first 
sign of reddening or fluctuation, 746 

Iron, syrup of the iodide, in anaemia, pre- 
scription for, 278, 746 

Lactophosphates, or hypophosphites, with 
cod-liver oil, useful in young children, 
746 

Phosphate of sodium or lime, if glands are 
breaking down, 129, 746 

Sulphurate of calcium, if suppuration is 
active, 746 

Thiol, recommended in scrofulous skin dis- 
eases, 416 

SCURVY, 747 
Arsenic and iron, of service in most cases, 

747 



Citric acid, if lemon-juice is not attainable, 
186, 747 

Diet, 747 

Lemon- or lime-juice, particularly indi- 
cated, 747 

SEA-SICKNESS. 

Bromides, the best prophylactics, 118 
Chloralamide and potassium bromide, 156 
Nitrite of amyl, 80 
Kola, 284 

SHOCK, 747 

Alcohol, 63 

Atropine, gr. ^j- to ^ (0.001-0.0012) hypo- 
dermically, with hot applications, very 
useful in first or second stage, 108, 748 

Digitalis, valuable as an adjuvant to atro- 
pine, 216, 748 

Heat, external, very useful, 749 

Hypodermoclysis, useful, 749 

Strychnine, very valuable, 334 

SKIN DISEASES. 

Arsenate of iron, 275 

Arsenic, in dry, scaly types, 97 

Bismuth subgallate, when there is much 
secretion, 112 

Boro-glycerin, 115 

Cod-liver oil, in strumous types, 196 

Copper sulphate, gr. ^ (0.005) thrice daily, 
if arsenic is not well borne, 204 

Corrosive sublimate, oz. £ (16.0), and am- 
monium chloride, oz. 1 (30.0), useful, 
added to bath, in syphiloderm, 306 

Hydrocyanic acid, in itching types, pre- 
scription for, 255 

Ichthyol in those forms associated with 
atony and induration of the deeper 
layers, 260 

Ointment of biniodide and of yellow oxide 
and lard, in equal parts, useful applica- 
tion, 307, 312 

Petrolatum, as an emollient dressing, 355 

Tar and suet, equal parts, locally applied 
except on face, 369 

Unguentum hydrargyri ammoniati, 305 

Zinc-oxide ointment, 346 

SMALLPOX, 749 

Aconite, with spirits of nitre and Min- 
dererus, useful as a fever mixture, 749 

Antipyrin or acetanilid, to control head- 
ache and backache, 88, 749 

Brandy and whiskey, if pulse fails, 749 

Bromides and chloral, in insomnia ; latter 
must be used carefully, 749 

Carbolic acid and sweet oil (1: 100), as an 
ointment to check irritation, 749 

Chlorate of potassium with tincture of 
myrrh, as a mouth -wash, 750 

Disinfection and hygiene necessary, 750 

Flexible collodion, glycerite of starch, or 
simple cerate, locally applied, to prevent 
itching, 749 

Iron, tincture of the chloride, to give 
strength and act as a specific, 749 

Mustard plasters contraindicated, 749 

Salicylic acid and vaseline, or cold cream 
(4 : 100), best local application, 749 



852 



INDEX OF DISEASES AND REMEDIES. 



Silver nitrate, locally applied, to prevent 
pitting, 321, 749 

SORDES. 

Glycerin and water, equal parts, useful as 
a mouth-wash, 243 

SORES. 

Acetic acid, in old sores, 56 

Black wash, useful for syphilitic sores, 307 

Camphor, locally applied, as a stimulant in 
indolent sores, 133 

Charcoal, applied to old sores, as a deodor- 
ant and antiseptic. 144 

Cold cream, as an emollient dressing, 378 

Dried alum a useful dressing. 72 

Formaldehyde solution useful for cauter- 
izing svphilitic sores, 238 

Gallic acid, 238 

Iodoform, gr. 20 (1.3), with oil of eucalyp- 
tus, oz. h (16.0), or iodoform, oz. £ (16.0), 
camphor, gr. 75 (5.0), and essence of 
roses, gtt. 2 (0.1), as a dressing for syph- 
ilitic sores, 270 

Petrolatum, as an emollient dressing, 355 

Potassium permanganate ( gr. 60 to the pint 
[4.0 : 500.0] ), as a wash, 355 

Quercus alba, powdered, as a poultice, to 
check discharge, 375 

Eed or yellow oxide of mercury a good 
dressing for syphilitic sores. 312 

Sulphuric acid, sometimes used as an es- 
charotic in venereal sores, 409 

Zinc-oxide ointment, 346 

SORE THROAT. 

Aconite, in early stage. 59 

Alum (gr. 20 to the ounce [1.3:30.0]), lo- 
cally applied on swab, 72 

Arsenic, 97 

Belladonna, of greatest service in some 
cases, 108 

Capsicum, tincture of, and glycerin, 140 

Carbolic acid (1 : 100), in spray, in ulcerated 
types, 143 

Catechu, as a gargle or in troches, 149 

Copper sulphate (gr. 4 to the ounce [0.2 : 
30.0]), often of service in relaxed sore 
throat. 205 

Guaiac, 245 

Hamamelis, in relaxed sore throat, 248 

Hydrogen peroxide (2 per cent, strength), 
in spray, in foetid types, 256 

Kino, as a gargle, 284 

Myrrh, tincture of, diluted one-half, as a 
gargle in ulcerated types, 317 

Potassium chlorate gargle in anginose form, 
prescription for. 157 

Quercus alba, useful as a gargle. 375 

Quinine (gr. 1 to 2 to the ounce [0.05-O.1 : 
30.0]), in spray, in foetid sore throat. 
183 

Rhus glabra, with glycerin and water, use- 
ful as a gargle, ''>~^ 

SPASMS. 
Belladonna, useful in urethral, anal, and 

vesica] spasm, 107 
Bromides in spasmodic contractions, 117 
Cannabis indica, useful in vesical spasm, 

136 



Conium, useful, if due to irritation of 

nerve-trunk, 201 
Ether, inhalation, relieves local spasms, 229 
Gelsemium in localized muscular spasms, 

240 
Hyoscyamus in local spasm or where pain 

is due to spasm, 257 
Xitrite of amyl, of service to relax, 80 

SPERMATORRHOEA. (See Emissions.) 



SPRAINS. 

Arnica, 94 

Camphor liniment, 133 

Cold applications, useful in sprained ankle, 

442 
Croton oil liniment, 209 
Hot-air bath, 474 
Hot bath, very useful in sprained ankle, 

473 
Ichthyol ointment, well rubbed in, very 

useful. 260 
Lead-water and laudanum, 288, 341 
Soap liniment, 395 
Soap plaster, used as a support to sprained 

joints, 395 
Soluble glass. 394 
Turpentine liniment, 424 
Warming plaster, 368 

STINGS AND BITES, 750 

Ammonia or alkaline liquids, locally ap- 
plied to neutralize poison, 750 

Carbolic acid (1 : 50 or 100). sponged over 
part, useful in mosquito-bites, 750 

Corrosive sublimate, with flexible collodion 
(1:1000 1, painted over part; salicylic 
acid a useful addition, 750 

Hydrogen peroxide applied locally to hor- 
net's sting, of great value. 257 

Ipecac paste for stings of bees, 273 

Ligature, or cleansing of wound, at once, 
to prevent absorption in snake-bite, 
750 

Potassium permanganate, applied and in- 
jected around snake-bite, followed by 
alcohol in full dose, 750 

Vinegar, dilute or pure, locally applied, 
often relieves insect-bites, 750 

STOMATITIS, 750 

Borax, as a mouth-wash, prescription for, 
113, 751 

Bromide of potassium or sodium, gr. 1 to 10 
(0.05-0.65), thrice daily, when nervous 
irritability is excessive. 751 

Carbolic acid, as a mouth-wash, 143 

Cleansing nipples, in breast-fed babies, 751 

Cocaine, before cauterization. 189 

Nitrate of silver, stick touched to sore spots 
when they fail to yield to other treat- 
ment. 321, 751 

Nitric acid, rn 3 (0.15), in water, taken 
through tube, 323 

Nitro-muriatic acid, indicated when he- 
patic torpor exists, 751 

Peroxide of hydrogen. 751 

Potassium chlorate, prescription for. 157. 
751 



INDEX OF DISEASES AND REMEDIES. 



853 



Salicylic acid (1 : 250), as a mouth-wash, 
after blisters have broken, to allay pain, 
382 

Salines or rhubarb, if constipation exist, 
751 

Sozoiodol (5 per cent, solution), locally ap- 
plied, 399 

Sweet spirit of nitre, 10 minims (0.65), well 
diluted, to a one- or two-year-old child, 
and a warm foot-bath, before retiring, 
to produce rest, 751 

Thymol, prescription for, 417 

Tonics and careful diet after the attack, 
751 

STYES, 751 

Boric acid (saturated solution), collodion 
(ethereal solution), or red or yellow ox- 
ide of mercury salve (gr. 2 to the ounce 
[0.1-30.0]), locally applied to abort, 751 
Calcium sulphate, if they tend to return, 

752 
Hot compresses, to alleviate pain, 752 
Incision, as soon as pus forms, 752 
Tonics, if general health is poor, 752 

SUBINVOLUTION OF UTERUS. (See In- 
volution, Anomalies of.) 

SUNBURN. 
Almonds, in emulsion, 69 
Carbonate of lead, prescription for, 288 

SUNSTROKE, 752 

Antipyretics, almost useless, 88 

Hot boths (105° to 110° F.), or hot bottles 
or bricks, in heat exhaustion, 753 

Ice, application to chest, back, and abdo- 
men, as quickly as possible, in thermic 
fever, 752 

Salicylic acid, quinine, and similar drugs 
contraindicated, 753 

Tonics, during convalescence in heat ex- 
haustion, 753 

Venesection, best treatment, if face be cya- 
notic and heart laboring, and if menin- 
gitis threatens, after thermic fever, 753 

Veratrum viride may be used if meningitis 
threatens, 753 

SYNCOPE. 

Ammonia, if due to shock or indigestion, 
75 

SYNOVITIS. 

Carbolic acid (2 per cent, strength), as an 

injection in chronic types, 144 
Counter-irritation, 460 
Iodine, 267 

SYPHILIS, 753 

Biniodide of mercury, 307 

Bismuth and calomel, as a dusting-powder, 
or bichloride solution (1 : 2000), locally 
applied to mucous patches about geni- 
talia, 756 

Calomel, gr. h (0.01), every two hours, for 
cephalalgia, 756 

Cod-liver oil, useful in advanced cases, 196, 
758 

Expectant plan of treatment, 754 



Formaldehyde solutiou, useful for cauter- 
izing sores, 237 

Hypodermic injections of mercury, 306, 312, 
758 

Iodides, followed if necessary by mercury, 
recommended by some, 262, 754 

Iodoform, gr. 1 to 5 (0.05-0.25), internally 
in tertiary stage, and the ointment ap- 
plied to ulcers, very useful, 270, 758 

Iodol, in tertiary stage, 271 

Mercurial ointment, by inunction, 311, 757 

Mercury, at beginning of secondary stage, 
followed later by the iodides, 754, 755 

Mercury by fumigation, general and local, 
300, 757 

Mercury, with chalk, chiefly employed in 
infautile syphilis, 310, 755 

Mixed treatment, 755 

Ointments and washes of mercury, and hot 
applications, to combat surface erup- 
tions, 756 

Prescription for blue mass and iron, 757 

Prescription for potassium iodide and mer- 
cury, to be used after first eighteen 
months, 756 

Pressure bandage and mercurial inunctions 
for periostitis, 755 

Protiodide of mercury, 312, 755 

Salicylate of mercury hypodermically, 312 

Sarsaparilla, a useful adjunct to potassium 
iodide, 389, 758 

Shampooing and local application of croton 
oil, or cantharides, as a lotion, to com- 
bat alopecia, 756 

Silver nitrate, copper sulphate, chromic acid 
solution (20 per cent.) or acid nitrate of 
mercury, locally applied to mucous 
patches, in mouth, 756 

Stillingia, used as an aid to other drugs, 402 

Thiol, in syphilides, 416 

Tonic and general treatment, 758 

Vapor baths, hypodermic injections, or in- 
unctions, useful modes of applying mer- 
cury if it cannot be taken by mouth, 
757 

SYSTEMIC STRAIN. 

Opium, useful in prolonged physical strain, 
341, 342 

Quinine, gr. 2 to 4 (0.1-0.2), useful to pre- 
vent exhaustion following physical and 
mental strain, 182 

TABES DORSALIS. (See Locomotor 
Ataxia.) 

Chloralamide, prescription for, 155 
TAPE-WORM. (See Worms.) 

TEETHING. 

Bromide of potassium, to prevent convul- 
sions, 118 

TETANUS, 758. (See Poisoning from 
Strychnine.) 

Ainyl nitrite, to relieve and prevent, 80 
Antitoxin, value of, not established, 758 
Chloral and bromide of potassium, by mouth 
or rectum, 154 



854 



INDEX OF DISEASES AND REMEDIES. 



Fowler's solution, said to be almost specific 

in some cases, 758 
Physostigma, of moderate value, 362 

TINEA CAPITIS. 

Lime-water, locally applied, 131 

TINEA CIRCINATA. 
Borax, strong solution, locally applied, 113 
Iodine, applied with camel's-hair brush, 

267 
Turpentine, useful, applied with a brush, 
424 

TINEA TARSI. 
Copper, crystals, or weak solution, applied 
to diseased eyelid, 205 

TINEA TONSURANS. 
Borax, strong solution, locally applied, 113 
Iodine, applied with camel's-hair brush, 

267 
Oil of cajuput, applied pure, 127 

TOE-NAILS (INGROWING). 

Absorbent cotton, soaked in strong alum 
solution, and inserted under nail, 72 

Liquor potassse. to soften nail prior to pack- 
ing with cotton or partial evulsion, 291 

TONSILLITIS, 759 

Alum stick, deeply applied, 72 

Ammonium iodide, for enlarged tonsils, 79 

Carbolic acid, solution (1 : 100), as an anti- 
septic gargle, 759 

Glycerin and tincture of capsicum, equal 
parts, applied by swab, 140 

Guaiac, 245, 759 

Guaiacol, applied locally, 759 

Hot fomentations and gargles useful in 
some cases, 759 

Hydrogen peroxide (2 per cent, strength), 
in spray, in ulcerative types, 256 

Ice-bag to throat, 759 

Iron, tincture of the chloride, 277, 759 

Monsel's solution, pure, applied with cam- 
el's-hair brush, 279 

Nitrate of silver, applied locally, 759 

Salicylates, are valuable in rheumatic cases, 
382, 759 

Saline purgative, followed by fever mixture 
of aconite, sweet spirit of nitre, and po- 
tassium citrate, 759 

Scarification may be of service in early 
stages, 759 

TOOTHACHE. 
Creosote, applied on cotton, often relieves, 

207 
Oil of cloves, inserted into cavity on cot- j 

ton. 187 
Oil of peppermint, applied on cotton, 352 

TORPOR. 
Acetate of potassium, in hepatic torpor, 56 
Ammonium chloride, in hepatic torpor, 78 
A rsenic, in gasl ric torpor, it? 
Citric acid, in hepatic torpor, 186 
EuonymUB, in mild hepatic torpor, 234 



Lactophosphates and hypophosphites, use- 
ful in hepatic torpor, 129 

Xitro-hvdrochloric acid, in torpor of liver, 
326 
! Eussian and Turkish baths, useful in tor- 
pidity of skin and kidneys, 475 

Taraxacum, in hepatic torpor, 414 

TORTICOLLIS. 

Belladonna, injected into muscles, 108 
Gelsemium, 240 
l Hot compresses, 474 



TREMOR. 



Hyoscine, 258 
Sparteine, 391 



TUBERCULOSIS, 759 

Acetanilid, generally acts unfavorably, 54 

Agaricin, of doubtful value in night- 
sweats, 61 

Almonds, essential oil of, recommended in 
cough, 68 

Alum (gr. 10 to 20 to the ounce ro.65-1.3: 
30.0]), or sulphuric acid (1 drachm to 
the pint [4.0:500]) useful, sponged 
over body in night-sweats, 763 

Antipyrin harmful, 88 

Arsenic, in phthisis, and in phthisical ten- 
dencies, 96, 97 

Atropine, gr. T ^ to T ^ (0.0004-0.0006), hy- 
podermicallv, in excessive night-sweats, 
763 

Blister, small, useful over new pleuritic 
spots, 762 

Camphoric acid, gr. 20 to 30 (1.3-2.0), in- 
valuable, 763 

Cannabis indica, 135, 762 

Carbolic acid (TIL 5 to 15 to the ounce [0.3- 
1.0:30.0]), in spray, 143 

Chloride of calcium, 128, 129 

Chloroform, spirit of, used by inhaler, often 
relieves cough, 762 

Climatic treatment, 500 

Codeine, recommended in excessive cough, 
194 

Cod-liver oil, rules for its use, 761, 762 

Copper in tubercular tendencies, 204 

Creosote, internally, in spray or by inhaler, 
often relieves cough and discomfort; 
contraindicated if fever and haemopty- 
sis are present ; prescription for, 207, 761 

Glycerin and water equal parts, with lem- 
on-juice, useful as a mouth-wash, 243 

Guaiacol, useful in, 245, 246 

Hydrogen peroxide (2 per cent, strength), 
in fine spray in laryngeal phthisis, 256 

Hygienic measures, 760 

Hypnal for cough, 259 

Inhalations of steam from corrosive subli- 
mate solution (1 : 10.000), stopping at 
first sign of mercurial effects, in laryn- 
geal phthisis ; precede inhalation with 
cocaine-spray (4 per cent, solution), 
762 

Iodine, useful, painted over new pleuritic 
spots, also useful in chronic cases as an 
inhalant. 267, 762 

Iodoform with small amount of powdered 
talc and a little morphine, useful when 



INDEX OF DISEASES AND REMEDIES. 



855 



puffed into the larynx in laryngeal tu- 
berculosis, 763 ; also used in spray, 270 

Iodoform emulsion (10 per cent.), useful in 
tubercular abscess, 270 

Iodol, of use in tubercular laryngitis, 271 

Lactic acid applications (10 to 60 per cent, 
solution), in laryngeal tuberculosis, 
using cocaine-spray first to relieve pain, 
"762 

Lactophosphates and bypophosphites, 129 

Morphine and wild-cherry bark in cough, 
prescription for, 762 

Nuclein, 330 

Oil of cloves, 187 

Opium, may be given in last stage, to re- 
lieve pain and discomfort, 242 

Oxygen, inhalations in dyspnoea, 347 

Pilocarpine, gr. ■£$ (0.003), one to two hours 
before sweat, sometimes arrests ; if it or 
atropine fails alone, give them together, 
763 

Potassium cyanide, in excessive cough, 
prescription for, 210 

Silver nitrate (gr. % to 2 to the ounce [0.03- 
0.1:30.0]), in spray, may be tried in 
laryngeal types, 322 

Strychnine, in dyspnoea, 334 

Sulphuric acid, internally, may relieve 
night-sweats, 763 

Terebene, iodide of ethyl, and chloroform, 
equal parts, for inhalation, 762 

TYPHOID FEVER, 763. (See Fever.) 

Acetanilid, generally acts unfavorably, 54 

Alcohol, useful throughout course of dis- 
ease, 63, 764 

Asafoetida, by rectal injections, in tympa- 
nites, 101 

Belladonna in cases of collapse or vaso- 
motor relaxation, 108 

Calomel, gr. £ (0.001), every fifteen min- 
utes, till gr. 1 (0.05) is taken, followed 
by magnesium sulphate, i ounce (15.0), 
if constipation lasts two days, 309, 766 

Cascara sagrada for constipation, 766 

Enemas, to be tried first, if constipation 
lasts over two days, 766 

Glycerin and water, equal parts, with a 
little lemon-juice, as a mouth-wash, if 
sores are present, 243, 766 

Guaiacol, an antipyretic in, 246 

Guaiacol carbonate, an intestinal antiseptic 
of value, 247, 766 

Hydrochloric acid, dilute, TT^ 5 (0.3) every 
few hours, or, if bowels are inactive, ni- 
trohydrochloric acid, TT^ 3 (0.15), 253, 
766 

Hypodermoclysis, if toxaemia is marked, 
767 

Lime-water added to milk, if vomiting 
threatens, 766 

Liquorice powder, drachm 1 (4.0) if con- 
stipation lasts over two days, 766 

Milk diet, 764, 766 

Morphine in large dose, if perforation oc- 
curs, 767 

Opium for insomnia, 341 

Phosphorus, if nervous svstem is affected, 
360 

Prescription for diarrhoea, 766 

Quinine inferior to new antipyretics, 182 



Eeduction of fever by cold, 442, 452 
Eest and diet, 764, 765 

Silver nitrate, gr. £ to i (0.011-0.015), high- 
ly recommended, 321 
Sulphocarbolate of zinc, useful, 405 
Thymol as an intestinal antiseptic, 417 
Turpentine, in the form of stupes, enemata, 
or by mouth, in tympanites, also useful 
hi later stage, to relieve diarrhoea, heal 
ulcers, and prevent relapse, 423, 766 
Venesection, contraindicated, 767 

(For remedies for complications — intesti- 
nal hemorrhage, pneumonia, and pleurisy 
— see their titles.) 

ULCERS. 

Alcohol, a useful local application, 64 

Aristol, 418 

Benzoate of bismuth, as a dressing for in- 
dolent or sloughing ulcers, 112 

Burnt alum, as a dressing for old ulcers, 72 

Caustic potash, as an escharotic for exu- 
berant ulcers, 149 

Chimaphila, said to be of service in stru- 
mous ulcers, 151 

Conium, used locally to relieve pain, 202 

Copper, in solid or powder form, locally 
applied to indolent ulcers, 205 

Creolin, solution (1 : 100), as a douche for 
nasal ulcers, 208 

Dried alum, useful, 72 

Europhen, in 10 per cent, ointment, in leg 
ulcers, 236 

Gallic-acid ointment, in actively discharg- 
ing ulcers, 238 

Glutol as an antiseptic powder, 238 

Hamamelis, locally applied on a cloth, re- 
lieves leg ulcers, 248 

Hot pack to increase activity of skin, 473 

Hydrogen peroxide, a useful application, 
257 

Lime, as an escharotic in old ulcers, 130 

Methyl blue in corneal ulcers, 314 

Nitric acid, as a caustic for phagedenic 
ulcers, or a solution (TT\, 5 to 30 to the 
ounce [0.3-2.0 : 30.0]), locally applied to 
indolent types, 323 

Ointment of lead carbonate as a dressing, 
288 

Potassium permanganate (gr. 60 to the pint 
[4.0 : 500]), as an antiseptic wash, 355 

Precipitated carbonate of calcium, as a dry 
dressing, 128 

Silver nitrate, in hard pills, for intestinal 
ulcers, and by injection for rectal aud 
c?ecal ulcers, 321 

Sulphuric acid, sometimes used as an es- 
charotic in slow ulcers, 409 

Unna's dressing, 346 

URiEMIA, 768 
Atropine useful in pulmonary oedema, 768 
Bromides for convulsions, 769 
Caffeine useful to stimulate the kidneys, 

768 
Chloral and chloroform for convulsions, 

769 
Elaterium thought to aid elimination of 

poison by the bowel, 210, 768 
Ether given by the mouth or hypodermic- 

allv, 229 



856 



INDEX OF DISEASES AND REMEDIES. 



Heroin for dyspnoea, 248 

Hot pack, 768 

Hypodermoclysis, 769 

Xitro-glycerin to increase the urinary flow 

when arterial tension is high, 768 
Pilocarpine, a most efficient remedy, 365, 

768 
Strychnine, followed by digitalis for heart 

failure, 768 
Transfusion of salt solution of great value, 

507, 769 
Venesection, very useful, 769 

URIC-ACID DIATHESIS. 

Acetate of potassium, 56 
Lime-water, 130 

Piperazine in the dose of 15 grains (1.0) a 
day in 1 pint (500) of water, 367 

URTICARIA. 

Calcium chloride, to prevent, 128 

UTERINE INERTIA. 

Kola useful, 284 

Quinine not of great value, 182 

UVULA (RELAXED). 
Capsicum, tincture of, and glycerin, equal 

parts, as a gargle, 140 
Kino, as a gargle, 284 

VARICOCELE. 

Cold water, applied by bidet, highly recom- 
mended, 448 

VARICOSE VEINS. 
Barium chloride, internally and locally ap- 
plied, said to be of value, 103 

VITREOUS DISEASES, 769 

Antisvphilitic treatment, if due to syphilis, 
769 

Galvanism, 769 

Leeches, in early stage, if due to inflam- 
mation, 769 

Pilocarpine, hvpodermically, in opacities, 
365, 769 

VOMITING, 769 
Acetanilid, very useful, 55, 770 
Allium-juice, ffV, 2 to 5 (0.1-0.3), useful in 

nervous vomiting, 68 
Arsenic in vomiting of pregnancy, and of 

hand-fed babies, and of drunkards, 97, 

771 
Bismuth and aconite may be of service, 

prescription for, 111, 771 
Brand v poured on cracked ice very useful, 

(il.*770 
Bromide of potassium, effervescing, 118 
Bromide of sodium, with laudanum as a 

rectal injection, prescription for, 119, 

341, 770 
Calomel, 309 
Carbolic acid or creosote, with bismuth, 

useful in acidity and fermentation, pre- 
script ion for, 143, 771 
Chloretone. if due to irritation, 158 
Chloroform, rr\, 1 to 2 (0.05-0.1), in water, 

771 



Cloves, oil of, sometimes controls, 187 
Cocaine or aconite, if due to hyperexcita- 

bility of stomach, 193, 770 
Enemas, partially digested, if vomiting is 

incoercible, 772 
Faradism sometimes gives relief, 772 
Fowler's solution, gtt. i to 1 (0.025-0.05), 

every two hours, useful in nausea fol- 
lowing debauch, 65, 772 
Hydrochloric acid, TT\, 5 to 15 (0.3-1.0), in 

water, every two hours, in alcoholic 

nausea, 253, 772 
Hydrocyanic acid, dilute, n\ 2 to 6 (0.1- 

0.4), in water, 255, 771 
Ice-bag to nape of neck, lumbar region, or 

epigastrium, 772 
Iodine and carbolic acid, tt\, 1 (0.05) of each 

in dr. 2 (8.0) of water, 771 
Ipecac, in small doses, if due to gastric de- 
pression, 272, 771 
Lime-water, added to milk, may relieve 

nausea, 130, 772 
Mustard plaster over stomach, useful in all 

cases, 772 
Nitro-glycerin, very useful in some cases, 

325, 771 
Nux vomica, if due to gastric depression, 

prescription for, 772 
Peptonized milk, best food, 772 
Podophyllin, useful in gastric depression 

and hepatic torpor, 370 
Seidlitz powder, often settles stomach, if 

due to constipation, 392 
Vinegar fumes of service when inhaled, 770 

VOMITING OF PREGNANCY. 

Aconite, as a nervous sedative, 59 

Arsenic, may be tried, 97 

Bromide of potassium, as an effervescing 
draught, or with opium, by enema, pre- 
scriptions for, 119 

Cerium oxalate, gr. 2 to 5 (0.1-0.25), in pill, 
every four or five hours, 150 

Cocaine, useful to decrease irritability, 192 

Iodine, tincture of, largely used of late 
with good results, 268 

Ipecac wine, TT\, 1 (0.05), or powder, gr. 2 
(0.1), useful in some cases, 272 

Menthol, very useful, 352 

WARTS. 

Acetic and salicylic acids combined, 56 
Chromic acid (gr. 100 to the ounce [6.5: 

30.0]), locally applied, to remove, 176 
Fowler's solution, locally applied, 98 
Glacial acetic acid, useful to remove, 56 
Nitric acid, as a caustic, 323 
Salicylic acid, locally applied, 98 
Trichloracetic acid, useful, 421 

WHOOPING-COUGH, 772 

Amber, oil of, 73 

Amyl nitrite, when paroxysms interfere 

with respiration, 80, 773 
Antipyrin, gr. \ to 3 (0.025-0.15), every live 

hours, probably the best remedy, 89, 

773 
Belladonna, tincture of, n\ 2 (0.01), twice 

a day, to child of one or two years, 107 
Benzine, 773 



INDEX OF DISEASES AND REMEDIES. 



857 



Bromoform, prescription for, 122, 773 

Bronchitis tent, to modify severity of at- 
tacks, 773 

Carburetted hydrogen, 773 

Chloral, 154 

Chloride of gold and sodium has been rec- 
ommended, 244 

Chloroform, a few whiffs, if paroxysms in- 
terfere with respiration, 168, 773 

Gelsemium, 240 

Hyoscyamus, probably better than bella- 
donna, 257 

Milk, in small amounts, may overcome 
vomiting following paroxysms, 773 

Monobromated camphor, 134 

Quinine (gr. 1 to the ounce [0.05:30.0]), 
in spray, useful, also of service in ex- 
posed children as a prophylactic, 182, 
773 

Eesorcin, n\, 10 (0.65), of a 2 per cent, so- 
lution, internally, or, better, in spray, 
375 

Silver nitrate (gr. £ to 1 to the ounce [0.025- 
0.05:30.0]), in spray, used when stom- 
ach is empty, 322 

WORMS, 773 

Aspidium, very efficient against tape-worm, 
prescription for, 101, 774 

Azedarach, a useful remedy against round- 
worms, 102 

Brayera, as an infusion, or fluid extract, 
against round-worms, 774 

Calomel, should follow or precede all drugs 
used for tape- worm, 774 

Castor oil, or a saline purgative, should fol- 
low remedies for round-worms, 774 

Chenopodium, oil of, TT\, 5 to 20 (0.3-1.3), 
on sugar, to remove round-worms, 140, 
774 

Chloroform, should not be used against 
tape-worm, 172 

Cusso in tape-worm, 210 

Kamala, drachms 1 to 2 (4.0-8.0), in syrup, 
against tape-worms, 283 



Koosin, gr. 40 (2.6), to adult, against round- 
worms, contraindicated in pregnant 
women, 774 

Matricaria, 297 

Pelletierine, gr. 3 to 5 (0.18-0.26), in capsule, 
best remedy against tape- worm, 774 

Pepo, ounce 2 (60.0), in confection, against 
tape-worm, 351, 774 

Pomegranate, useful in tape-worm, 371, 774 

Quassia injections, preceded by soap and 
water, most useful remedy against seat- 
worms, 374, 774 

Rue, should not be used against round- 
worms, 379 

Rules for diet preceding tseniacides, 774 

Salicylic acid, gr. 8 (0.6), hourly till gr. 40 
(2.6) are taken, against round-worms, 
or as an injection against seat-worms, 
prescription for, 382 

Santonin, gr. i to £ (0.016-0.3), in troches, 
for child, against round-worms, 388, 774 

Spigelia, alone, or, better, with senna, to 
remove round-worms, 400, 774 

Turpentine and castor oil, equal parts, effi- 
cient, but somewhat dangerous, against 
tape- worm, 423, 424 

WOUNDS. 

Acetanilid as a dusting-powder, 55 
Alcohol, very useful in contused wounds, 64 
Collodion, as an air-tight dressing for small 

wounds, 199 
Glutol, as an antiseptic powder, 238 
Oil of cinnamon, 185 
Potassium permanganate (gr. 20 to 60 to the 

pint [1.3-4.0 : 500]), as an antiseptic 

wash, 355 
Salicylic acid, 383 
Sozoiodol, as an antiseptic and disinfectant 

in diseased wounds, 399 

YELLOW FEVER. 

Cocaine of great value as a stimulant and 
anti-emetic, 192 






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